1 AUGUST 2019 This publication was produced at the request of the United States Agency for International Development (USAID). It was prepared independently by Saha Consulting and Services. It was authored by Lutuf Abdul-Rahman (MSc), Abubakari Abdulai (PhD), Nashiru Sulemana (PHD) and David Yao Mensah (PhD). FINAL REPORT END LINE BENEFICIARY-BASED SURVEY (EBBS) OF USAID|GHANA’S RESILIENCY IN NORTHERN GHANA (RING) PROJECT PAGE INTENTIONAL LEFT BLANK ENDLINE BENEFICIARY￾BASED SURVEY (EBBS) OF USAID|GHANA’S RESILIENCY IN NORTHERN GHANA (RING) PROJECT FINAL DRAFT REPORT August 27, 2019 [Agreement Number: AID-641-C-14-00002] DISCLAIMER The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. CONTENTS CONTENTS ........................................................................................................................................................i LIST OF FIGURES.............................................................................................................................................ii LIST OF TABLES.............................................................................................................................................. iii ACRONYMS....................................................................................................................................................... v EXECUTIVE SUMMARY................................................................................................................................ vii 1. PROJECT BACKGROUND ......................................................................................................................1 2. EVALUATION PURPOSE & EVALUATION QUESTIONS ...............................................................3 2.1. EVALUATION PURPOSE...................................................................................................................................3 2.2. EVALUATION QUESTIONS ..............................................................................................................................3 3. EVALUATION METHODS & LIMITATIONS.......................................................................................2 3.1. STUDY DESIGN...............................................................................................................................................2 3.2. STUDY POPULATION ......................................................................................................................................2 3.3. DATA COLLECTION APPROACHES ..................................................................................................................2 3.3.1. Sample size determination and sampling techniques......................................................................................3 3.3.2. Data collection tools and data sources for study questions..............................................................................4 3.3.3. Recruitment and training of survey teams and pre-testing of survey tools ........................................................5 3.3.4. Ethical issues and consent ............................................................................................................................6 3.3.5. Quality control in data collection ...................................................................................................................6 3.4. ANALYTICAL APPROACH ................................................................................................................................. 6 3.5. LIMITATIONS ..................................................................................................................................................7 4. FINDINGS, CONCLUSIONS & RECOMMENDATIONS....................................................................8 4.1. CHARACTERISTICS OF SAMPLED POPULATION ..............................................................................................8 4.2. QUESTION 1...................................................................................................................................................9 4.3. QUESTION 2.................................................................................................................................................19 4.4. QUESTION 3.................................................................................................................................................23 4.5. QUESTION 4.................................................................................................................................................25 4.6. QUESTION 5.................................................................................................................................................29 Annexes ............................................................................................................................................................. 36 ANNEX II: SUMMARY OF PROJECT BENEFICIARIES BY DISTRICT AND ALLOCATION OF SAMPLE SIZE ....................59 ANNEX III: SOURCES OF INFORMATION..................................................................................................................59 ANNEX IV: DATA COLLECTION INSTRUMENTS .......................................................................................................60 ANNEX V: SOURCES OF DATA BASED ON EVALUATION THEMES AND KEY EBBS QUESTIONS..............................61 ANNEX VI: INDICATORS AND MEASUREMENT APPROACHES FOR KEY STUDY QUESTIONS ..................................62 ANNEX VII: DISCLOSURE OF ANY CONFLICTS OF INTEREST ...................................................................................65 ANNEX VIII: RESULTS OF CORE 18 INDICATORS BY DISTRICT AND TYPE OF HOUSEHOLD ...................................69 ANNEX IX: LIVELIHOOD INTERVENTIONS RESULTS - EBBS 2019 .............................................................................93 ANNEX X: DECISION MAKING ACROSS ALL INTERVENTIONS (COMPARISON OF 2017 BBS ................................110 ANNEX XI: HOUSEHOLD INCOME SOURCES AND FINANCIAL SECURITY.............................................................111 ANNEX XII: HOUSEHOLD RESILIENCE RELATED TO FOOD SECURITY..................................................................113 LIST OF FIGURES Figure 1: Prevalence of stunting among children under five years ............................................................................................. 9 Figure 2: Stunting prevalence by age ................................................................................................................................................10 Figure 3:Prevalence of wasting among children under five years ............................................................................................11 Figure 4: Wasting by age .....................................................................................................................................................................12 Figure 5: Prevalence of underweight among children under five years ...................................................................................13 Figure 6: Underweight by age ............................................................................................................................................................13 Figure 7: Changes in community engagement with District Assembly and its units in the last 2 years .........................18 Figure 8: Beneficiaries who indicated they would continue interventions after RING support has ended...................26 Figure 9: Whether respondent was rearing small ruminants for the first time ....................................................................95 Figure 10: Material used for small ruminant pen construction .............................................................................................. 100 Figure 11: What respondents who keep their animals in pens do with the animal dropping ........................................ 102 Figure 12: Whether beneficiary was farming soybeans before RING .................................................................................. 103 Figure 13: Source of land for soybeans cultivation .................................................................................................................... 103 Figure 14: Respondents who sold part of their LGV ................................................................................................................ 108 Figure 15: Places respondents sold their LGV............................................................................................................................ 109 Figure 16: Source of water for irrigating LGVs .......................................................................................................................... 109 LIST OF TABLES Table 1: Summary of project beneficiaries and sample size ......................................................................................................... 3 Table 2: Performance of component 1 indicators ........................................................................................................................15 Table 3: Performance of component 2 indicators ........................................................................................................................16 Table 4: Performance of component 3 indicators ........................................................................................................................18 Table 5: Satisfaction rating of services provided to improve health,, WASH and agriculture ..........................................19 Table 6: Performance of selected indicators among HH that benefited from single intervention ..................................30 Table 7: Number of interventions HH benefitted from and performance in key indicators ............................................30 Table 8: Decision making on the sale and use of proceeds from soybeans and leafy green vegetables .........................32 Table 9: HL.9-a: Prevalence of stunted children under five years of age by sex, age group and district .......................69 Table 10: HL.9-c: Prevalence of underweight children under five years of age by sex, age group and district ............70 Table 11: HL.9-b: Prevalence of wasted children under five years of age by sex, age group and district ......................71 Table 12: Financial Security by type of HH and district ..............................................................................................................72 Table 13: Post harvest reduction techniques by HH type and district ...................................................................................73 Table 14: HHs reporting shorter lean season by HH type and district ..................................................................................75 Table 15: HHs reporting a reduction food consumption last year by HH type and district .............................................76 Table 16: Number of months HH adjusted food intake by district .........................................................................................77 Table 17: Change in household income as a result of RING by HH type and district .......................................................78 Table 18: HHs reporting shorter lean period by HH type and district ..................................................................................79 Table 19: Percentage of HHs reporting improved nutrition practices by HH type and district ......................................80 Table 20: Number of nutrition practices adopted by HH type and district ..........................................................................81 Table 21: Knowledge of appropriate IYCF practices by HH type and district .....................................................................82 Table 22: Number of service delivery channels reported to mainstream appropriate nutrition messages by HH type and district ..............................................................................................................................................................................................83 Table 23: Women dietary diversity by district ..............................................................................................................................84 Table 24: Percentage of children who met minimum acceptable diet.....................................................................................85 Table 25: Minimum dietary diversity for children 6-23 months................................................................................................85 Table 26: Prevalence of exclusive breastfeeding of children under six months of age by HH type and district ..........85 Table 27: Percentage of households with soap and water at a handwashing station commonly used by family members by HH type and district ....................................................................................................................................................87 Table 28: Availability of handwashing facilities by HH type and district .................................................................................88 Table 29: Percentage of HHs practicing correct use of recommended HH water treatment technologies by HH type and district .....................................................................................................................................................................................89 Table 30: Percentage of respondents who knows any 3 critical times of hand washing ....................................................90 Table 31: Number of local government nutrition and livelihood services that recoded improvement by HH type and district ..............................................................................................................................................................................................91 Table 32: Percentage of respondents who reported seeing improvement in 6 or more services by HH type and district ......................................................................................................................................................................................................92 Table 33: Sources of money for VSLA savings (multiple response) .........................................................................................93 Table 34: Comparison of last year’s and this year’s income......................................................................................................93 Table 35:Uses of money from VSLA share out (multiple response) .......................................................................................93 Table 36: Challenges encountered as a VSLA member (multiple response) .........................................................................94 Table 37: Percentage of VSLA members who took VSLA loans, amount take as loan and what it was used for .......94 Table 38: Percentage of VSLA members who will continue to be VSLA members after the current cycle ended ....94 Table 39: District level results for # of small ruminants received, births and deaths # missing, sold and amount generated from sale ..............................................................................................................................................................................95 Table 40: Number of small ruminants currently available by district ......................................................................................96 Table 41: Small Ruminants Management - # sick and # reported ............................................................................................96 Table 42: Whether respondent households have sold animals to date by district ..............................................................97 Table 43: Number of small ruminants sold by district ................................................................................................................98 Table 44: Amount generated from small ruminant sale by district ..........................................................................................99 Table 45: Reasons for selling small ruminants (multiple response) ....................................................................................... 100 Table 46: Material used for small ruminant pen construction by district ............................................................................ 101 Table 47: What respondents who keep their animals in pens do with the animal dropping by district .................... 102 Table 48: District level results on access to soy beans cultivating before RING, access to land, land size and harvest ................................................................................................................................................................................................................ 104 Table 49: Quantity of soybeans for HH consumption and sale (multiple response (MR)) ............................................. 104 Table 50: Post-harvest management and sales decision making ............................................................................................ 105 Table 51: Number of months respondents had soybeans for home use ............................................................................ 105 Table 52: District level results on vines received & planted, quantity harvested, sold and amount earned .............. 105 Table 53: Respondents who will continue OFSP cultivation after the projec .................................................................... 106 Table 54: Sources of vines for those who want to continue OFSP cultivation after the project ................................. 106 Table 55: Type of vegetables cultivated by LGV beneficiaries ................................................................................................ 107 Table 56: Months with access to LGVs for HH consumption and access to and running of drip irrigation system 107 Table 57: Quantity (kg) of LGVs harvested by type of HH .................................................................................................... 107 Table 58: Quantity (kg) of LGVs consumed at home by type of HH ................................................................................... 107 Table 59: Quantity (kg) of LGV sold by type of HH ................................................................................................................. 108 Table 60: Uses of income from LGV sale .................................................................................................................................... 108 Table 61: Person who makes decision when it comes to taking VSLA loan ...................................................................... 110 Table 62: Person who makes decision when it comes of sale of small ruminants ............................................................ 110 Table 63: Person who makes decision when it comes of sale of soy beans ....................................................................... 110 Table 64: Person who makes decision on how to use the income earned from soy bean sale .................................... 110 Table 65: Person who makes decision when it comes of sale of LGV ................................................................................. 110 Table 66:Person who makes decision when it comes of sale of OFSP ................................................................................ 111 Table 67: HH financial security and sources and changes in HH income ............................................................................ 111 Table 68: HH income sources as a result of RING, availability of additional income sources to purchase food, comparison of current income and that of last year and the management of surplus food ........................................... 112 Table 69: Percentage of HHs that adjusted food intake because they did not have enough food, changes in period food intake was adjusted and availability of extra income to purchase food ..................................................................... 113 Table 70: Number of months HHs adjusted food intake because they did not have enough food ............................. 114 ACRONYMS ADS Automated Directives System AMEP Activity Monitoring and Evaluation Plan CI Confidence Interval COO Chief of Operations COP Chief of Party CU5 Children Under Five DAs District Assemblies EBBS Endline Beneficiary-Based Survey FGD Focus Group Discussion FY Fiscal Year G2G Government-to-Government GC Global Communities GOG Government of Ghana HH Household IYCF Infant and Young Child Feeding KII Key Informant Interview LEAP Livelihood Empowerment Against Poverty LGV Leafy Green Vegetables M&E Monitoring and Evaluation MAD Minimum Acceptable Diet METSS Monitoring, Evaluation and Technical Support Services MMDA Metropolitan, Municipal and District Assemblies MTMSG Mother to Mother Support Group NGO Non-Governmental Organization NRCC Northern Regional Coordinating Council OFSP Orange Flesh Sweet Potato PICS Purdue Improved Crop Storage PIL Project Implementation Letter RING Resiliency in Northern Ghana RPCU Regional Planning and Coordination Unit SOW Statement of Work SPRING Strengthening Partnerships, Results, and Innovations in Nutrition Globally TL Team Leader USAID U.S. Agency for International Development USG US Government VSLA Village Savings and Loans Association WASH Water, Sanitation and Hygiene WDD Women’s Dietary Diversity ZOI Zone of Influence vii EXECUTIVE SUMMARY PROJECT BACKGROUND The RING project was a US$60 million USAID|Ghana and Feed the Future-funded five-year integrated project that contributed to the Government of Ghana’s (GOG) and the USG’s Feed the Future (FTF) Initiative’s efforts. The goal of the project was to improve livelihoods and nutritional status of vulnerable households (HHs) in targeted communities in 17 Metropolitan, Municipal and District Assemblies1 (MMDAs) in the Northern Region of Ghana. The project interventions were developed around five technical areas namely; nutrition, governance, water, sanitation and hygiene (WASH), agriculture and livelihoods. The Project was implemented through these 17 MMDAs and the Northern Regional Coordinating Council (NRCC) and its decentralize units and departments respectively, along with technical assistance from Global Communities Inc., a U.S. based non-governmental organization (NGO). Implementation was funded either through direct awards from USAID or through subcontract from Global Communities to the MMDAs and the NRCC. EVALUATION PURPOSE AND EVALUATION QUESTIONS The purpose of the end line beneficiary-based survey (EBBS) was to satisfy the monitoring and reporting requirements of the RING Project. To achieve its purpose, the EBBS answered the under listed questions.  To what extent has the RING Project achieved its intended goal and objectives as defined by the results framework?  What unintended outcomes has the RING Project’s Livelihood approach and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level?  What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (Effectiveness)? To what extent are the RING interventions likely to continue after USG support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (Sustainability)  Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status, and hygiene practices? (Efficiency and effectiveness) EVALUATION DESIGN, METHODS AND LIMITATIONS The survey was designed as a cross-sectional mixed method, to allow for the comparison of survey findings with the baseline and midline. Secondary data was obtained through the review of project documents and Feed the Future research methods and instruments. The primary quantitative data was collected through a HH survey and the qualitative through Focus Group Discussions (FGDs) and Key Informant Interviews (KII). Multi-stage sampling was employed in selecting the beneficiaries for the HH survey. All selections were done using the random sampling function of SPSS. The HHs were selected from 16 out of the 17 MMDAs since one of them (Chereponi) had some security challenges at the time of data collection. This however did not affect the sample size since it was distributed among the remaining 16. The qualitative data was collected from selected staff of the NRCC and the MMDAs and its departments and units respectively and Global Communities. The qualitative data was analyzed using NVivo (version 12) and the quantitative using SPSS version 20. The anthropometric data was analyzed using the World Health Organization’s (WHO) Anthro 3.2.2 Survey Analyzer. Project performance was assessed by comparing the EBBS findings with that of the baseline and 1 This is the same as District Assemblies as used in parts of this report viii the project targets. The main limitation of the study was the conflict in Chereponi District which made it impossible to collect data from beneficiaries in that district at the time. FINDINGS AND CONCLUSIONS Question 1: To what extent has the RING project achieved its intended goal and objectives as defined by the results framework? Question 1a: Progress towards the achievement of the project goal The findings of the EBBS show that stunting prevalence (28.4%) had reduced by almost 2 percentage points among children under five (CU5). The reduction in severe stunting which reduced from 12.73% to 6.60% contributed to the marginal reduction in overall stunting. The reduction in stunting among girls (3.28%) was higher than in boys (0.79%). A 7.73 percentage point reduction of stunting among 0-23 months was recorded between the baseline (17.73%) and end line (10.0%). The EBBS found that 23.1% of all the children under five were wasted. This reflects 8.14 percentage points increase in overall wasting with that of the boys increasing by 11.16% and girls 5.39%. Like in the baseline, more boys (23.6%) were wasted than girls (19.6%). Wasting levels increased between 0-5 months and 6- 11 months and then decreased with increasing age. Like wasting, underweight recorded a 9.81 percentage points increase between the baseline (25.59%) and endline (31.4%). The increase in underweight at the endline was due to an increase in moderate underweight [baseline 13.55% and endline 24.5%]. Severe underweight however recorded a reduction from 8.04% at baseline to 6.5% at endline. The underweight prevalence among boys (34.1%) was found to be higher than girls (28.5%), the girls recorded a relatively lesser percentage increase as compared to the boys; that is 8.91% and 10.60%, respectively. The findings also showed the levels of underweight increased gradually from birth to when children were 12–23 months old before it started to decline. Question 1b: Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD) The project contributed to increasing the knowledge of the beneficiaries on key infant and young child feeding (IYCF) practices from 35% at baseline to 100% at endline. The number of service delivery channels that mainstreamed appropriate nutrition messages were 8 at the endline as compared to the project target of 5. The increased knowledge contributed to the adoption of some improved nutrition practices. These included women's dietary diversity (WDD) (Mean of 3.7 at baseline compared to 4.3 at endline); children receiving minimum acceptable diet (MAD) (from 10% to 64.4%) and exclusive breastfeeding (from 60% to 74.3%). Question 1c: How has Global Communities RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). Decentralized units of the MMDAs indicated that the implementation of project activities has helped them visit the communities regularly and they are better able to interact with communities and get feedback on activities which are then used to inform planning for future ones. About 6 out of 10 beneficiaries (60.3%) interviewed indicated that in the last year, staff from the decentralized units engaged members of their communities to plan on addressing their community's challenges in health, agriculture, and WASH. ix The percentage of HHs reporting improvement in nutrition and livelihood services from local government increased from 11.5% in 2017 (midline) to 100% at endline, exceeding the project target by 25%. Despite the improvement, the majority (average of 77.2%) of the beneficiaries indicated that these efforts were not enough to address the nutrition, WASH, agriculture and livelihood challenges of their communities. Conclusions question 1 Overall, it was observed that there was a remarkable improvement in IYCF knowledge and practices and hygiene practices among beneficiary HHs. The improvement in infant and young child feeding and hygiene practices could be attributed to the capacity empowerment of service providers and the increase in channels for receiving IYCF and hygiene information. However, all these improvements in the area of practice and service provision had only modest gains in improving the nutritional status of children under five years in the beneficiary communities as there was only a slight reduction in severe stunting. They are however promising, and it is expected that in the medium term these improvements will translate into improved nutritional status. Recommendations question 1 Sustained effort is required to get the improved IYCF and WASH knowledge coupled with the increased financial security of vulnerable HHs to translate into a reduction in malnutrition rates. These efforts will need to address HH food shortage and the use of extra income at the HH level. Question 2: What unintended outcomes has the RING project’s livelihood approach and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level? Only a few positive unintended outcomes were identified. No negative unintended outcomes were identified although some challenges were observed which could have limited the project performance. The FGDs with the project beneficiaries revealed that the project had improved upon their social capital as the regular meetings of the VSLA brought about more social capital and social cohesion in their societies. Most of the members mentioned that VSLA activity has brought unity and togetherness among the women of the community. As one of the participants in a FGD stated, “…now we have the confidence to speak in public and now we know and care more about each other” (Beneficiary FGD-Participant, Sagnarigu). The cohesion among stakeholders was also reported at the MMDAs and the NRCC level. This was mainly attributed to the joint planning which enables the different units and departments to understand the activities of each other and to learn to work together in activity implementation. Some challenges that were not anticipated in the design might have affected the project performance. Delay in the release of funds from the USAID to the Assemblies and from Assemblies to decentralized units was seen as one factor which could have limited project performance. Findings indicated that some of the activities were unduly delayed due to this late release of funds. The delay in the release of funds by USAID in some situations was due to the delays on the part of the MMDAs to retire funds already released to them. It was also indicated that although the project design was very good as it focused on government agencies to carry out implementation, making Global Communities responsible for results when funds were sent directly to the District Assemblies was problematic and it led to conflict in roles where the Assemblies sometimes did not know whether to go to Global Communities or NRCC when they need support. Some MMDA staff, however, indicated that the staff from some of the Regional Departments were not very x responsive when they reached out for support hence, they had to resort to technical specialists at Global Communities. Conclusions question 2 Unintended results such as the promotion of cohesion and understanding of each other’s work among departments of the NRCC and decentralized units of the MMDAs might have helped in improving project activities implementation. Similarly, the cohesion and improved social capital coupled among VSLA beneficiaries may have contributed to improving the achievement of project results. The challenges might have limited the achievement of project results. The inability of some stakeholder to understand the roles of NRCC and Global Communities limited the benefits such stakeholders could have derived from complementary roles of the two organizations. Recommendations question 2  On the side of the District Assemblies, future projects should include measures on funds release to units as a key performance indicator.  Sending funds to District Assemblies directly helps to strengthen the decentralization system and should be continued. However, future projects should make MMDAs responsible for their results or give contractors some authority to hold MMDAs accountable for results. Question 3: What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (effectiveness)? The key lessons learned, and best practices are discussed below.  Not allowing communities and beneficiaries to select interventions may have limited benefits: Stakeholders at the regional, district and community levels were of the view that the effectiveness of the interventions was reduced by not allowing communities to select the interventions they were interested in. For example, in the case of the small ruminants, they were of the view that beneficiaries should have had options of different animals to choose from depending on the prevailing conditions in their communities.  Effective community engagement is key to project success: Community engagement contributed to enhancing the project's effectiveness. Stakeholders at District Assembly and community level noted that community engagement is so valuable in driving home change in the community.  Use of multiple channels to provide behavior change communication information ensured beneficiaries increased access to information: The use of several channels such as health facilities, VSLA meetings, radio, schools, meetings with Agric Extension Agents etc to provide IYCF and WASH information ensured that beneficiaries had constant access to information, and this contributed in increasing their knowledge.  VSLA remains an effective avenue for delivering information to community members: It was so easy to deliver key information on critical health, nutrition, and WASH to community members using the VSLA platform and no extra resources were needed to mobilize the women.  Joint planning and review promote collaboration among departments and units: The joint planning and review was seen to promote cohesion and collaboration among units and departments at the District Assembly and NRCC levels respectively. This also promoted experience sharing and learning. Conclusions question 3 Lessons such as the use of multiple channels to enhance information provision and VSLA as an opportunity to deliver critical IYCF and WASH information were identified and used to enhance project results. xi The effect of not allowing communities and beneficiaries to select interventions of interest on project performance was not identified during the project implementation, therefore no steps were taken to allow it to happen or to mitigate any limiting effect it might have on project results. Recommendations question 3  Future interventions should consider developing a menu of activities for communities to select from.  The use of multiple communication channels should be continued by future interventions.  The use of VSLA as a platform for the delivery of key messages should be promoted in future projects. However, care should be taken to limit the number of add on activities in other not to prolong the meeting times. Question 4: To what extent are the RING interventions likely to continue after USG support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (sustainability) It was generally observed that beneficiaries would be able to continue the livelihood activities after the RING support has ended. The most promising ones according to the stakeholders included the VSLA and OFSP as it may require less effort to keep it running. Almost all the VSLA beneficiaries (99.3%) and 91.8% of OFSP beneficiaries indicated they will continue their activities after the RING project has ended. Some Regional and district level stakeholders held a contrary view in the case of OFSP. They were of the view that it could not be stored for a long time and beneficiaries might not be able to purchase the vines after the project is ended. The results from the HH survey however indicate most beneficiaries will not purchase vines because they preserve their vines and can also obtain it from friends. Whilst soybeans did not feature in the FGDs and KII interviews as one of the activities which can be sustained, most of the beneficiaries (89.3%) indicated they will continue to farm soybeans after the RING support has ended. The small ruminant intervention was also seen as one that the beneficiaries can continue beyond the project. WASH activities in the area of constructing latrines and handwashing stations also have some chance of being sustained because the focus was on the use of local material and beneficiaries were given the skills to construct it on their own. The MMDAs can continue to support beneficiaries to continue their activities after the project has ended by providing basic support like fuel because the project had laid a good foundation for that through capacity building and logistics support. The activities that can be continued through this approach are VSLA, mother to mother support groups (MTMSGs)), community lead total sanitation and the community livestock worker approach because they require limited investment. The MMDAs will however not have the resources to continue to implement the soybeans and small ruminants' intervention by adding new beneficiaries because they are very expensive. Community livestock workers can however provide support to beneficiaries to maintain their small ruminants. Conclusions question 4 The findings show a clear buy-in from the beneficiaries, hence their willingness to continue activities after the project has ended. It was generally observed that some of the interventions like VSLA, OFSP, MTMSGs and community-led total sanitation had the highest chance of being continued by the beneficiaries after the RING support had ended with little or no support from the MMDAs. The rearing of small ruminants has potential although not like the others. Its sustainability will require the provision of critical services such as para vet. xii The MMDAs would not be able to have new beneficiaries in small ruminants and soybeans. However, for VSLA and OFSP they could easily do that through providing fuel for field activities. Recommendations question 4  MMDAs should focus on providing fuel support to decentralized agencies to continue to provide regular support to beneficiaries especially the VSLA and MTMSGs and explore how they could use it to sustain other interventions.  In future projects, the MMDAs should be tasked to take over and fund some project activities during the life of the project. This can be factored in as a performance measure and tied to continued funding under the project. Question 5: Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status, and hygiene practices? (efficiency and effectiveness) The nutrition interventions focused on improving IYCF knowledge and practices among the beneficiaries was quite effective since the target of most of the IYCF knowledge and practice indicators were met. For the WASH interventions, the distribution of the ceramic filters and aqua tabs and the construction of water harvesting facilities for HHs were seen to be the least effective. These interventions were quite expensive and delivered little value, as a result, they were discontinued. The most effective WASH intervention was the Community-Led Total Sanitation. The results of the key indicators by the number of interventions a HH received did not show any clear trend that increasing the number of interventions a HH benefited from would shorten the period it experienced lean season, increased the practice of exclusive breastfeeding or enhance HH financial security. However, for HHs reporting they now have increased/ diversified income sources as a result of RING intervention and the availability of handwashing facility with soap, there was a clear trend. As the number of interventions per HH increased the proportion that had increased/more diversified income sources increased. Similarly, as the number of interventions increases the proportion with handwashing facility with soap/ash increases but does not increase further when more interventions are added after the third one. Conclusions question 5 The project was quite successful in identifying and stopping ineffective and inefficient interventions which helped in improving the effectiveness and efficiency of the project. It was not possible to tell which single interventions were more effective than the other because of the lack of baseline and midline figures to compare. However, the results suggested that supporting HHs with more than one intervention (layering) could be effective and help them to improve their resilience faster. Recommendations question 5  USAID should continue to allow some flexibility for future projects to be able to discontinue activities that are found to be ineffective and inefficient.  Nutrition information and counselling interventions are effective in increasing knowledge on IYCF, however, a lot more is needed to move the increased knowledge to practices that will reflect on the nutritional status of children.  The layering of interventions should be promoted as part of all projects targeting the poor and vulnerable. 1 1. PROJECT BACKGROUND The Resiliency in Northern Ghana (RING) project was intended to demonstrate the development hypothesis that strengthening local networks (i.e. district and regional structures) to develop, implement and monitor nutrition, Water, Sanitation and Hygiene (WASH), and livelihoods activities would improve beneficiary nutrition and hygiene behaviors, which, in turn, would improve the nutrition and health status of women of reproductive age and children under five in targeted vulnerable households. The project had three components and five technical areas (nutrition; governance; water, sanitation and hygiene; agriculture and livelihoods) that contributed to the program goal to improve livelihood and nutritional status of vulnerable households in targeted communities in the Northern Region of Ghana. The main objectives of the program were: Component 1: Increased access and consumption of diverse quality food among target households, especially among women & children under five (CU5); Component 2: Improved behaviors related to nutrition & hygiene for women & CU5; and Component 3: Strengthened local support networks addressing the ongoing (nutrition & livelihoods) needs of vulnerable households. Through the project interventions, RING was expected to contribute to the following results between June 2014 and September 2019: ● 100% increase in income of 80% of target households (HH); ● 20% decrease in prevalence of stunting among children under five; ● 20% decrease in prevalence of anemia among children under five; ● 20% decrease in prevalence of underweight among children under five; and ● 20% decrease in prevalence of wasting among children under five. The goal of the RING Project was to improve livelihoods and nutritional status of populations in Northern Region2, Ghana, which experiences the highest and most persistent rates of poverty and food insecurity in the country. The project was a US$60 million USAID|Ghana and Feed the Future-funded five-year integrated project that contributed to the Government of Ghana’s (GOG) and the United States Government’s (USG’s) Feed the Future (FTF) Initiative’s efforts, which was implemented to sustainably reduce poverty and malnutrition. The project aimed to improve the livelihoods and nutritional status of vulnerable households in partnering districts in the most food-insecure parts of the Northern Region. The RING Project’s interventions were implemented through 17 Metropolitan, Municipal and District Assemblies3 (MMDAs) and the Northern Regional Coordinating Council (NRCC), along with technical assistance from Global Communities Inc., a U.S. based non-governmental organization (NGO). Using a data- and criteria-based approach to select communities and the target households, approximately two thousand five hundred 2 For most of the life of the project, the 17 MMDAs partnering with RING were found in the Northern Region. However, in early 2019, the Northern Region split into three different regions, including North East and Savannah Regions. RING partner MMDAs are now found in all three regions, but this report will refer to Northern Region for consistency. 3 This is the same as District Assemblies as used in parts of this report 2 (2,500) vulnerable households were selected from each of the 17 partnering MMDAs in the Northern Region as beneficiaries. The project was implemented in collaboration with seven departments within the NRCC, including the Regional Planning and Coordination Unit (RPCU) and other technical regional directorates/departments such as the Regional Environmental Health and Sanitation Unit (REHSU), Regional Agriculture Department (RAD), Regional Department of Gender (RDOG), Regional Department of Community Development (RDCD), Regional Department of Social Welfare (RDSW), and the Northern Regional Health Directorate (NRHD). Implementation was funded either through direct awards (i.e. Project Implementation Letters or PILs) from USAID or through subcontract from Global Communities. 3 2. EVALUATION PURPOSE & EVALUATION QUESTIONS 2.1. EVALUATION PURPOSE The purpose of the end line beneficiary-based survey (EBBS) was to satisfy the monitoring and reporting needs of the RING Project by providing data to gauge the performance of 18 survey-related indicators in the RING Project’s Activity Monitoring and Evaluation Plan (AMEP). Specifically, the EBBS sought to provide data: (1) To estimate changes in outcomes and outputs since baseline (2) To determine the project’s interventions that are more effective at improving livelihoods.; and (3) To determine the effectiveness of activity management strategies for key interventions within the agriculture, livelihoods, nutrition, good governance, and WASH components of the RING Project. The findings of the EBBS would also inform the project partners (USAID/Ghana, Global Communities RING and the target MMDAs and the NRCC) about which of the project interventions have worked well and why, which perhaps have not and why. USAID and its partners would use the information provided to inform post-project scale-up of the most promising RING activities and to inform future design of similar projects. 2.2. EVALUATION QUESTIONS The following questions guided the evaluation process: 1. To what extent has the RING Project achieved its intended goal and objectives as defined by the results framework? a. Has the RING Project’s government to government (G2G) interventions at the district level resulted in sustainable reduction in hunger and malnutrition for households, especially among children under five? (Malnutrition is measured by the nutritional indices of children under-five and hunger is measured by length of months without available food); b. Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are the Minimum Acceptable Diet (MAD) and Women’s Dietary Diversity (WDD) scores); c. How has Global Communities RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). 4 2. What unintended outcomes has the RING Project’s livelihood approach4 and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level? 3. What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (Effectiveness)? To what extent are the RING interventions likely to continue after the United States Government (USG) support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (Sustainability) 4. Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status, and hygiene practices? (Efficiency and effectiveness) The detailed statement of work is shown in Annex I. 4 The approach is to engage with targeted households on several activities designed to diversify income streams. Initial support includes intensive training on asset management, followed by asset transfer (such as sheep or poultry), then supportive monitoring over time, typically 2-3 years to monitor growth of the herd/flock and to address periodic health and asset management issues as they arise. It also includes input support to targeted farmers (i.e. seeds, land preparation services), coupled with training and monitoring over the course of the first year. The second year, the farmers receive only inputs and monitoring, and by the third year, farmers only receive monitoring support/extension services from district agriculture staff. 3. EVALUATION METHODS & LIMITATIONS This section presents the methods that were used to collect and analyze the data required for the evaluation. The section outlines the survey design, survey population and sampling, data collection methods and data analysis. Strategies to ensure data quality are also described. 3.1. STUDY DESIGN The survey was designed as cross-sectional mixed methods, to allow the team gain rich insights and comprehensive understanding of the project performance and results and to allow for the comparison of survey findings with previous surveys such as the baseline and midline. The SPRING and RING baseline study served as the source of baseline data, whilst the 2017 Beneficiary-Based Survey (BBS) complimented with the RING midterm evaluation, provided the midline values. The data collected by the EBBS was therefore compared with these in addition to the project targets to determine the extent to which the project's goal, objectives, and key results were met. The quantitative data which served as the basis of assessing the extent to which project results were achieved was complemented with qualitative data which, among others, provided the lessons learned in project implementation and a deeper understanding of the findings. The study design also made provision for the review of secondary data. 3.2. STUDY POPULATION The survey population was individual beneficiaries of the RING project interventions in 16 out of the 17 project MMDAs of Northern region. Chereponi was not included because there was an ongoing ethnic conflict at the time of the data collection. Staff of 6 selected MMDAs and their Decentralized units and that of the NRCC and its Departments were also part of the study population. Selected staff of Global Communities were also interviewed. The unit of analysis was therefore the individual beneficiaries or HHs, dependent on the indicator and staff of the MMDAs and the NRCC. 3.3. DATA COLLECTION APPROACHES The study made use of both secondary and primary data. The secondary data was obtained through the review of project documents and Feed the Future research methods and instruments as listed below.  Activity Monitoring and Evaluation Plan (AMEP) with indicator reference sheets  BBS 2017 data collections tools and report  RING Midterm performance evaluation report  SPRING and RING baseline report with data collection tools  Master list of RING Communities by district  Master lists of household and beneficiaries by intervention and community  Draft evaluation questionnaires  Feed the Future Zone of Influence survey methods questionnaire 2018 The document review enabled the survey team to get a deeper understanding of the project and its interventions. It also helped in ensuring that the EBBS methodology was aligned to that of the 2017 3 BBS and the baseline to ensure that the results were comparable. The result of the review was also useful in the review and adaptation of the draft evaluation HH questionnaire. The primary quantitative data was collected through a (HH survey and the qualitative through Focus Group Discussions (FGDs) and Key Informant Interviews (KII). 3.3.1.Sample size determination and sampling techniques The EBBS adopted the 2017 BBS survey approach to determine sample size. With this approach, the sample size was calculated to be representative at the project intervention level. The sample size per intervention for the whole project was therefore calculated and distributed to the districts using proportional to size sampling. The sample size for each intervention was determined using a 95% confidence interval, 5% margin of error, response distribution at 50% and the Raosoft sample size calculator http://www.raosoft.com/samplesize.html). The calculated sample size for each intervention was adjusted for a 10% non-response rate and all of them added together to give a sample size of 2,063 (Table 1). Table 1: Summary of project beneficiaries and sample size Project intervention # of beneficiaries* EBBS sample size 10% non￾response rate effective sample size Village Savings and Loans Associations 75547 383 38 421 Soybeans 22500 378 38 416 Small Ruminants 15485 375 38 413 Leafy Green Vegetables with Drip Irrigation System 5030 357 36 393 Orange Flesh Sweet Potatoes 51133 382 38 420 Total 169,695 1,875 188 2,063 *These are not unique beneficiaries because some beneficiaries received multiple interventions The total sample size was allocated to 16 out of 17 beneficiary MMDAs5 based on the proportion of the total RING beneficiaries in each MMDA. The number of beneficiary communities from which the HH with beneficiaries were selected for interview in each district was determined by dividing the sample size allocated to that district by 18. The number 18 was based on a comparison of the sample size for the SPRING/RING baseline and the 2017 BBS with the number of communities visited in each case, which showed that an average of 20 and 17 respondents were interviewed in each community respectively. Annex II shows the summary of the total project beneficiaries by district and the sample size allocated to each district. Multi-stage sampling was employed in selecting the beneficiaries. The first stage involved the selection of communities within the districts and the second stage, the selection of beneficiaries within the sampled communities. The random sampling function of SPSS was used to sample the number of communities required in each district, controlling for the different interventions. This ensured that communities that benefited from different interventions were covered appropriately to meet the total 5 Chereponi District was not part of the EBBS because of tribal conflict in the district at the time of data collection. 4 sample size needed for each of the interventions. In each sampled community, the same SPSS function was used to sample the beneficiaries, ensuring that beneficiaries of different intentions were covered. In each sampled community, 18 beneficiaries with 5 replacements were randomly selected. The list of beneficiaries for each community was shared with the survey team. Since some of the beneficiaries benefited from multiple interventions, they responded to all sections of the questionnaire related to the interventions they benefited from. Twelve (12) communities (approximately 10%) of the 116 sampled communities were selected for the beneficiary focus group discussions. These communities were purposively selected focusing on communities that benefited from multiple interventions. Two communities each were selected from 6 (West Gonja, East Mamprusi, Nanumba South, Saboba, Karaga, Kumbungu, Savelugu-Nanton) of the 16 districts covered by the EBBS. The district selection was carried out purposively to ensure that districts with different dominant ethnic groups were covered. More districts with Dagombas as the dominants ethnic group was however selected to enable us also to see if there were any difference in the pre-urban districts and the more rural districts. The number of participants for each FGD ranged from 8 to 12 beneficiaries. As in the selection of communities, FGD participants were selected based on their level of involvement in beneficiary group activities. FGDs were also held with staff of 6 MMDAs selected for the beneficiary FGDs. This involved RING project focal persons from all the decentralized units. Key informant interviews were however held with one District Coordinating Director (Kpandai district) and RING Component Leads for Nutrition, WASH, Agriculture, and Livelihoods. At the regional level, FGDs were held with key NRCC staff6 involved in the project implementation. Regional level key informants were the Regional Nutrition Officer, RING Focal Person from Regional Agriculture Department, Regional Environmental Health Officer and the Regional Director of the Department of Gender. 3.3.2.Data collection tools and data sources for study questions HH questionnaire: The HH questionnaire (attached as Annex IV) was used to interview project beneficiaries. It provided information on 18 RING survey-based indicators. The HH questionnaire was discussed with RING and USAID Monitoring and Evaluation Technical Support Services project (METSS) and based on their input, the final questionnaire was produced. The questionnaire was piloted and field-tested during the training of Data Collectors. The final questionnaire was programmed into survey CTO to enable the use of tablets to collect data. Paper versions of the questionnaire were also taken to the field in case the tablets failed for any reason the paper version could be used and later entered into the application. FGD and Key-informant interviews (KII): The KIIs and FGDs (qualitative data collection) among others focused on unintended outcomes; lessons learned; drivers of change; sustainability; perceptions on the most effective and least effective interventions and factors promoting and limiting the achievement of project results. The questions for each group of stakeholders focused on the role they played in the project implementation. The qualitative data collection tools are shown in annex IV. Annex V shows the EBBS questions and the data collection tools used to collect data to address them. 6 Planning Officer; Planning Officer; Senior Planning Officer and, Planning Officer 5 Development and Finalization of Survey Tools: The consulting team referred to the RING AMEP for the definition of indicators. The under-listed documents and questionnaires were also used to guide the process of drafting and finalizing the survey tools.  FTF Ghana Population-based Survey in Northern Ghana: Baseline Protocol  RING and SPRING baseline questionnaire  2017 BBS questionnaire  Nutrition and poverty in Northern Ghana questionnaire  2014 Ghana Demographic and Health Survey questionnaire  Feed the Future ZOI Survey Methods - Questionnaire – 20181201  Feed the Future Indicator Handbook – March 2018 The draft survey tools were submitted to RING and METSS for review. After the review, there was a joint session with Saha Consulting and Services team to look at the comments from RING and METSS and to jointly address such comments in consultation with the RING Components Teams. Saha Consulting finalized the tools based on the feedback. The finalized tools were pre-tested in one of the beneficiary communities and the process used to further improve on the tools before the training and final pilot by the survey teams. 3.3.3.Recruitment and training of survey teams and pre-testing of survey tools Fifty-six (56) Data Collectors and 14 Team Leaders (TL) were recruited and invited for training. The minimum requirements for TLs were a bachelor’s degree, at least 4 previous experience as a TL in a HH survey and an ability to speak at least one of the local languages in the RING supported MMDAs. For the Data Collectors, the minimum requirement was a Higher National Diploma, an ability to speak one of the local languages in the project MMDA and experience working as a Data Collector in at least 2 previous HH surveys. To ensure that enough Data Collectors for each of the languages was recruited, the number of Data Collectors for each language was determined and used as the basis of the recruitment. For each language group, the number of Data Collectors recruited was more than what as needed. In the recruitment, consideration was also given to TLs and Data Collectors who have experience carrying out anthropometric measurement and ladies. The 14 Team Leaders (TL) and 56 Data Collectors recruited were taken through a 5-day training. The training focused on getting them to understand the purpose of the survey; the data collection tools; the sampling procedure for the quantitative aspect of the survey; data collection techniques and ethics. A session of the training also allowed the Data Collectors to familiarized themselves with the tablets and the questionnaire in survey CTO collect. Data collectors also role-played interviewing each other and with the support of the consultants translated the data collection tools and the consent forms into the various local languages of the survey area. The role-plays helped the interviewers identify and resolve the complexities of collecting data from respondents. The Team Leaders participated in the Data Collectors training. They were however given extra training on team dynamics, how to monitor and review data collected and how to randomly selected and crosscheck interviews conducted by the Data collectors. The Data Collectors and TLs were also trained in anthropometry with a focus on those with nutrition qualification and anthropometric measurement experience so they could take responsibility for the anthropometric measurement during the field survey. 6 As part of the training, the Data Collectors and TLs also got the opportunity to practice how to identify sampled beneficiaries in the field and to pilot the questionnaire on the Survey CTO platform. The questionnaires were amended, where necessary, based on the results of the pilot. RING provided support to the training with selected Project Component staff taking turns to participate in the training on days questions related to their components were discussed. They each made brief presentations of their components for Data collectors to have a better understanding of the project’s components and how each contribute to achieving the project’s goal. They also provided technical explanations to questions and supported in responding to other technical inquiries. Out of the 70 people who participated in the training, the best 48 Data Collectors (34 male; 14 females) and 12 TLs (10 males; 3 female) were selected to form 12 teams of 5 each for the data collection. Qualitative interviews were conducted by the consultants. 3.3.4.Ethical issues and consent Data collectors informed sampled HH heads of their mission and went through a consent process as part of the questionnaire administration. Only HHs that gave their consent to the process were interviewed. A copy of the consent form was given to the HH. 3.3.5.Quality control in data collection Several steps were taken to ensure that quality data was collected. The first step was the training of the data collectors to ensure that everybody had the right and common understanding of the questions and that the translations were done correctly. The presence of TLs to support Data Collectors in identifying the sampled HHs, helping them to resolve challenges; review of collected data and re￾checking interviews was another set of ensuring the collection of quality data. As part of the quality control, the TLs were required to re-check some key questions among 10% of respondents interviewed by each Data Collector. The teams also met every evening to review the day’s work and to discuss any challenges. The TLs would bring such challenges to the attention of the Consultants, if they could not resolve them at their level. Another level of quality control was unannounced visits by the consultants, METSS and RING staff to the teams to observe how the process was going and to provide feedback to them. For the first 3 days of data collection, the Lead Consultant reviewed all the data submitted for logic and inconsistencies and provided feedback to teams. To enhance information sharing and quick resolution of challenges, a WhatsApp group made up of the TLs, the consultants and selected RING staff was formed. This also ensured that the responses given were seen by all TLs. 3.4. ANALYTICAL APPROACH The analysis of the 18 core indicators was guided by the indicator definition and measurement defined in the AMEP. Reference was made to the 2017 BBS and the Feed the Future indicator handbook of March 2018. Annex VI presents the outline of the indicators that guided the consultants in answering the study questions. 7 Analysis of Qualitative Data: The qualitative data was analyzed using computer-assisted qualitative data analysis software NVivo (version 12) (QSR International Pty Ltd, Doncaster, Victoria, Australia). The field notes and audio recordings that were obtained during the data collection were transcribed verbatim and a thematic analysis performed. The analysis begun by reading, coding, and then categorizing the qualitative transcripts. Coding nodes were created based on the study objectives, the main themes of the interview and the focus group discussion guide. Specifically, the coding was done by finding references to different ideas, concepts or categories in the form of sentences, phrases and paragraphs within the sources (transcript), which represent them. When a meaningful segment of the text was found, a code was assigned, or category name to signify that segment. This continued until all the text was segmented. To ensure accuracy, the process was repeated several times to identify and code all the relevant segments to the study objectives. Analysis of Quantitative Data: The quantitative data (HH questionnaire) was analyzed using SPSS version 20. The indicators were calculated using percentages and the results compared with that of the 2017 BBS and the SPRING and RING baseline. The assessment focused on the project effect and not impact since there was no control groups at both baseline and end line. Community-level weights were calculated and used for the data analysis. The anthropometric data was analyzed using the World Health Organization’s (WHO) Anthro 3.2.2 Survey Analyzer7 to generate sex-specific z-scores. Biologically implausible z-scores (scores below -6 and above +6) were removed from the endline analysis. 3.5. LIMITATIONS The conflict in Chereponi District affected the collection of data from that district. As a result, beneficiaries from the district were not included in the study. However, this did not affect the sample size, since it was distributed among the rest of the 16 districts. . 7 https://whonutrition.shinyapps.io/anthro/ 8 4. FINDINGS, CONCLUSIONS & RECOMMENDATIONS This section of the report presents the main findings, synthesis, and analysis of the results of the EBBS. The findings are presented by the evaluation questions, with that of each question followed by conclusions and recommendations for that question. 4.1. CHARACTERISTICS OF SAMPLED POPULATION Respondents were categorized under the five intervention groups that they each benefitted from, namely Village Savings and Loans Association (VSLA), Small Ruminants, Leafy Green Vegetables (LGV), Soybeans and Orange Fleshed Sweet Potato (OFSP). The majority (45.5%) of them benefitted from two interventions; 18.7% benefited from three interventions; 8.1% and 3.5% benefited from four and five interventions respectively. The HHs that benefited from only one intervention made up the remaining 24.2%. Besides being beneficiaries of the RING interventions, 18.5% of the respondents interviewed were also beneficiaries of the government’s Livelihood Empowerment Against Poverty (LEAP) program. The HH classification results showed that the majority were male headed (92.7%). Female headed HHs were 7.2% and child headed8 0.1%. Islam was the most common religion (61.7%) of the respondents, followed by Christianity (26.3%) and Traditional Religion (9.9%). Those without any religion made up 1.9% with 0.3% belonging to other religions. The majority (43.8%) of the survey respondents belonged to the Mole-Dagbani ethnic group, 36.2% were Konkomba; 16% Guan; with Ewe and Anufu making up 2.3% and 0.4%, respectively. Other ethnic groups such as Akan, Grusi etc made up the remaining1.3%. Eighty-nine percent (89%) of the respondents were married with 7.3% being widowed and 1.9% single or never married. Those who were either in informal consensual union or living together and those separated or divorced were 1.3%. About 0.5% did not respond to the question of marital status. On English literacy, as much as 89.3% of the respondents could not read and write in English language. Only 9.5% could read and write in English language. The remaining 1.2% could only sign. The ability to read and write another language was equally very low with 89.5% not being able to do this. Only 5.4% could read and write in a local language and 3.9% in Arabic. The rest (1.2%) were able to read and write in Arabic and another local language. 8 HH headed by people less than 18 years of age 9 4.2. QUESTION 1 TO WHAT EXTENT HAS THE RING PROJECT ACHIEVED ITS INTENDED GOAL AND OBJECTIVES AS DEFINED BY THE RESULTS FRAMEWORK? a. Has the RING Project's G2G interventions at the district level resulted in a sustainable reduction in hunger and malnutrition for households, especially among children under five? (Malnutrition is measured by the nutritional indices of children under-five and hunger is measured by length of months without available food); b. Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD); c. How has Global Communities RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). Question 1a: Progress towards the achievement of the project goal Prevalence of stunting (height-for-age) among children under five years Nutritional status of children 0-59 months is an important determinant of child survival9. The period from pregnancy to age 5 is especially important for physical, mental and cognitive growth and health and development of the child. However, this period is also when issues with poor nutrition and repeated infections may interfere with the child’s optimal growth10. Stunting reflects a failure to achieve expected height relative to a healthy well-nourished child of the same age. Being stunted or low height-for-age is (height for age < –2 SD of the WHO Child Growth Standards median) is associated with poor food intake during pregnancy, inappropriate child feeding practices, infection and insufficient nutrient intake10. Stunting reflects chronic malnutrition. Figure 1: Prevalence of stunting among children under five years 9 Chataut J, Khanal K. (2016) Assessment of Nutritional Status of Children under 5 Years of Age in Rural Nepal. Kathmandu University Medical Journal (KUMJ). 14(53):73–7. 10 Chirande L, Charwe D, Mbwana H, Victor R, Kimboka S, Issaka AI, Agho KE (2015) Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey. BMC Pediatr. 2015;15(1):1–13 https://doi.org/10.1186/s12887-015-0482-9. Cluster Survey 2017/18. Snapshot of findings 30.46% 32.19% 28.50% 28.68% 31.40% 25.40% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% Overall Boys Girls BASELINE EBBS 10 The findings of the EBBS (figure 1) shows that stunting prevalence (28.4%) had reduced by almost 2 percentage points among the CU5s in the project districts. The prevalence was found to be lower than the prevalence (29%) reported by the 2017/2018 Ghana Multiple Cluster Survey in Northern Region11 and that of the baseline (30.4%). The prevalence found in the EBBS was also slightly lower than the 31.4% reported by 2018 USAID/Ghana Evaluate for Health Project in the Nutrition and Poverty in Northern Ghana Study12. Further analysis of the results shows that a reduction in severe stunting contributed to the marginal reduction in overall stunting. It reduced by almost half, from a baseline of 12.73% to end line value of 6.60%. Analysis also showed that, stunting was very low among children 0- 5 (10.2%), 6-11 (8.9%) and 12-23 months (10.9%) compared to older children: 24-35 (30.6%), 36-47 (39.9%) and 48-59 months (41.9%) (Figure 2). Similar observations were also made by USAID/Ghana Evaluate for Health Project11 when stunting and a child’s age in months were examined, it showed that stunting was lower among children 0-23 months and increased with age until 30 months. The average prevalence of stunting among children 0-23 months is 10%. This implies there was a 7.73 percentage point reduction of stunting between baseline (17.73%) and end line (10.0%) among children 0-23 months. The improved knowledge of households in appropriate infants and young child feeding practices (100%) as found in the EBBS, contributed in increasing the proportion of children meeting minimum acceptable diet (64.5%) and increased prevalence of exclusive breastfeeding from 60% at baseline to 74.3% at end line (Table 3) which could have contributed to the reduction in stunting. The mean women dietary diversity scores also increased from 3.7 at baseline to 4.3 at end line, which suggest beneficiaries who conceived three years ago may have had optimal preconception and pregnancy nutrition leading to optimal fetal growth contributing to reduction of stunting prevalence among younger children (0-23 months) as stunting may start as early as from pregnancy13. Figure 2: Stunting prevalence by age There was an increase in moderate stunting between the baseline (17.73%) and endline (21.9%). The results as shown in figure 1 further shows that the reduction in stunting among girls (3.28%) was higher than in boys (0.79%). This is contrary to the findings of the USAID Evaluate for Health Study12, in which the reduction of stunting was higher in boys than girls although very marginal and similar to its 11 Ghana Multiple Indicator Cluster Survey 2017/18. Snapshot of findings. 12 USAID/GHANA Evaluate for Health (2019) Nutrition and Poverty Reduction in Northern Ghana 13 Chirande L, Charwe D, Mbwana H, Victor R, Kimboka S, Issaka A.I., Agho K.E. (2015) Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey. BMC Pediatr. 2015;15(1):1–13 https://doi.org/10.1186/s12887-015-0482-9. 2.7% 2.4% 5.0% 7.3% 9.6% 9.9% 7.5% 6.5% 9.5% 23.3% 30.3% 32.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 0-5 6-11 12-23 24-37 38-47 48-59 Severe stunting Moderate stunting 11 findings that overall stunting rate was lower among girls than boys. In an analysis of 16 Demographic and Health Survey data from Sub-Saharan Africa, Wamani et al14 attribute the lower prevalence of stunting among girls as compared to boys like that to the EBBS to preferences in feeding practices or other types of exposures. Prevalence of wasting (weight-for-height) among children under five years Figure 3 shows the prevalence of wasting. Wasting or thinness (below -2 standard deviations from median weight for height of WHO Child Growth Standards) is a measure of current nutritional status. It reflects a recent weight loss which is usually due to acute food shortage or disease. The measurement of wasting therefore tends to be affected more by seasonal availability of food. Figure 3:Prevalence of wasting among children under five years The EBBS found that 23.1% of all the children under five were wasted. Like the baseline, more boys (23.6%) were wasted than girls (19.6%). It was observed that the levels of moderate wasting were higher than severe wasting, same as in the baseline. These findings show that overall wasting had increased by 8.14 percentage points with that of the boys increasing by 11.16% and girls 5.39%. As an indicator of current nutritional status, high rates show that the beneficiaries might not have had enough food to eat during the immediate period before the survey. The study took place at the peak of shea nuts harvesting, and it was observed that a lot of the mothers were involved in shea nut picking which could have limited the mother’s ability to provide optimal care, during the immediate period before the data collection. The fall armyworm invasion of farms in some areas in Ghana including the Northern Region in the last two years could have worsened the food security situation compelling households to adapt more drastic coping strategies, which might have resulted in the increased prevalence of wasting at endline. In a similar study among RING and SPRING beneficiaries in the Northern Region, they indicated the fall armyworm inversion and poor ran fall patterns contributed to reduction in HH food consumption15. 14 Wamani H, Åstrøm AN, Peterson S, Tumwine JK, Tylleskär T (2007). Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr. 2007;7(1):17 15 USAID/GHANA Evaluate for Health (2019) Nutrition and Poverty Reduction in Northern Ghana 14.69% 15.14% 14.21% 23.10% 26.30% 19.60% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% Overall Boys Girls BASELINE EBBS 12 Variation of wasting according to age was also observed. There were increasing levels of wasting from 0-11 (Figure 4) months which is similar to the observation by previous studies in Northern Region 16,17. The highest level of wasting was observed in children 6-11 months (Figure 4). This observation is like previous studies conducted in Northern Region16,17. The 6 -11 months period is the time children begin to receive complementary foods to complement breast milk and age at which breastfed infants are introduced to complementary foods is associated with increased risk of diarrheal diseases from contaminated weaning foods and gastric disturbances due to limited ability of the infant digestion system to handle complex carbohydrate and protein from plant sources18. This limits the ability of the infant to absorb nutrients hence the high prevalence observed in children 6-11 months in the EBBS. Figure 4: Wasting by age Prevalence of underweight (weight-for-age) among children under five years Underweight status reflects both chronic and acute malnutrition. A child is considered underweight if his/her weight is < -2 standard deviations from that of WHO Child Growth Standard median for well￾nourished children reflect both chronic and acute malnutrition. The level of underweight among the project beneficiaries recorded an increase of 9.81 percentage points (figure 5). The decrease in stunting prevalence as discussed earlier might reflect reduction in chronic malnutrition and the increase in wasting prevalence could reflect increase in acute malnutrition. Therefore, the increase in underweight which is affected by both chronic and acute malnutrition may be due more to the increase in acute malnutrition since chronic malnutrition might have recorded a decrease. Factors such as acute food shortage and disease which affect current acute malnutrition may be responsible for the increase in underweight. 16 Ghana Multiple Indicator Cluster Survey 2017/18. Snp shoot f findin.gs 17 Glover-Amengor et al. (2016). Nutritional status of children 0–59 months in selected intervention communities in Northern Ghana from the Africa RISING project in 2012 Archives of Public Health (2016) 74:12 DOI 10.1186/s13690-016- 0124-1 18 Cohen R, Brown K, Dewey K, Canahuati J, Landa Rivera L. (1994) Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet. 1994;344(8918):288–93. 9.3% 10.8% 6.9% 4.3% 0.8% 1.1% 26.1% 31.3% 29.1% 14.5% 7.0% 4.9% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 0-5 6-11 12-23 24-37 38-47 48-59 Severe wasting Moderate wasting 13 Figure 5: Prevalence of underweight among children under five years The underweight prevalence among boys (34.1%) was found to be higher than among girls (28.5%). The girls recorded a relatively lesser percentage increase as compared to the boys; that is 8.91% and 10.60%, respectively. The increase in underweight at the endline could be due to an increase in moderate underweight from a baseline figure of 13.55% to an endline figure of 24.5%. Severe underweight however recorded a reduction from 8.04% at baseline to 6.5% at endline. Figure 6: Underweight by age Further analysis also shows (figure 6) that levels of underweight increased gradually from birth to when children were 12–23 months old (0-5 months: 16.3%, 6-11 months: 30.9% and 12-23 months: 34.9%) and then levelled off to the third year of life (24-35 months: 33.6%) before it started to decline (48-59 months: 28.2%). This observation is like that made among children of beneficiaries of the USAID the Africa RISING Project in Northern Ghana, as the evaluation of the project19 also found that underweight levels increased from birth and then level off in the third year and declined. 19 Glover-Amengor et al. (2016). Nutritional status of children 0–59 months in selected intervention communities in northern Ghana from the Africa RISING project in 2012 Archives of Public Health (2016) 74:12 DOI 10.1186/s13690-016-0124-1 21.59% 23.50% 19.59% 31.40% 34.10% 28.50% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% Overall Boys Girls BASELINE EBBS 4.6% 5.9% 6.0% 7.6% 7.3% 5.6% 11.7% 25.0% 29.9% 26.0% 26.0% 22.3% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 0-5 6-11 12-23 24-37 38-47 48-59 Severe underweight Moderate underweight 14 In general children from vulnerable HHs are more likely to suffer from severe forms of undernutrition. Since RING targeted vulnerable HHs, the children of the beneficiaries were likely to have poorer nutritional status and the project effect on the nutritional status of beneficiaries’ children has started to show in the reduction of the severe forms stunting, wasting and underweight which is more likely to affect children from vulnerable HHs. The relatively lower rates of stunting, underweight and wasting among girls as compared to boys may be due to “biological fragility” because growth velocity among boys is slightly more rapid compared to girls and their growth is perhaps more likely to be affected by nutritional insults or other disease or exposures20. Progress towards the achievement of objectives The three components of the project as listed below reflect the results expected to be achieved based on the objectives. The achievement of the results related to these components is expected to contribute to the achievement of the project goal. The achievement of the objectives was assessed in relation to the achievement of the project indicators for these components. 5. Component 1: Increased access and consumption of diverse quality food among target households, especially among women & CU5; 6. Component 2: Improved behaviors related to nutrition & hygiene for women & children; and 7. Component 3: Strengthened local support networks addressing the ongoing (nutrition & livelihoods) needs of vulnerable households The results for the four component indicators are shown in Table 2. The performance measurement of this component of the project was based on HH income, financial security, and adaptation of post￾harvest loss management techniques. As shown in Table 2, all beneficiaries of crop interventions adopted at least one method of managing post-harvest losses. This exceeded the project target of 75% of beneficiaries adopting techniques for postharvest loss reduction. The adoption of these techniques would have contributed to a reduction in post-harvest losses for the beneficiary HHs. Reduced post￾harvest losses would mean HHs would have more of their harvest for sale and consumption. The most widely used techniques were the Purdue Improved Crop Storage (PICS) bags (56.1%); improved mud silos (28%) and ground tarpaulins (12.2%). The EBBS findings further showed that, a lot of progress was made in meeting the targets for increasing incomes and financial security of the beneficiary HHs. Seventy-six percent (76%) of the HHs reported increasing their income through RING supported activities and 69.1% reported being financially secured as a result of the project’s supported activities. There was very little difference in the percentage of female headed HHs and the two types of male headed HHs who reported being financially secured. A similar observation was made in the case of the proportion of HHs who have increased their income through RING supported activities. 20 García Cruz LM, González Azpeitia G, Reyes Súarez D, Santana Rodríguez A, Loro Ferrer (2017). Factors associated with stunting among children aged 0 to 59 months from the central region of Mozambique. Nutrients. 2017;9(491):1-16. https://doi.org/10.3390/nu9050491 15 Table 2: Performance of component 1 indicators Performance Indicator LoP targets BBS 2017 EBBS 2019 % of target achieved Component 1 Result: Increased access to and consumption of diverse quality food among target households, especially among women and children under five Intermediate Result 1c: Increased availability of affordable, diverse plant and animal foods throughout the year among target households 1.1.2.1: % of households who state they are more financially secure 70.0% 33.0% 69.1% 98.7 1.1.3.1: % of target households benefiting from crop intervention reporting use of techniques to reduce post￾harvest losses 75.0% 87.0% 100.0% 133.3 1.1.3.2: % of target households reporting shorter lean season as compared to the previous year 70.0% N/A 41.9% 59.9 1.1.3.6: % of targeted households who have increased their income through RING supported activities 80.0% N/A 76.0% 95.0 The use of the post-harvest loss reduction techniques was expected to lead to improved access and availability of food. The increased financial security could be as a result of the HHs selling the food produced since they will now have more because postharvest losses have been reduced by adopting the right techniques. This is particularly the case because the measurement of post-harvest lost reduction techniques was based on soybean, which is generally a cash crop. As a result of the increased and diversified income the HHs obtained through the project interventions, the HHs had more money they could spend on food. About 7 out of every 10 HHs (70.2%) reported having additional income which could be used to purchase food when the need arises. The results however show that this money might not have been spent on food. Only about 42% of the beneficiary HHs reported having a shorter lean season as compared to the year proceeding the EBBS data collection. The project's target of 70% at the end was missed. More male headed HHs (44.6% both adult male and female reported a shorter lean season as compared to the female headed with only adult male (28.4%) and female headed HHs (36.6%). The findings of the EBBS also show that 76.7% of the beneficiary HHs reduced their food intake or consume foods they would normally not consume at some point in the last 12 months preceding the survey. This reflects food insecurity and might have contributed to the missing of targets on malnutrition rates. Question 1b: Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD) The component 2 of the project focused on the adoption of positive nutrition, hygiene, and sanitation behaviors. As shown in Table 3, all HHs interviewed reported having adopted an improved nutrition behavior21. This was 17.6% more than the projects’ target of 85%. The targets of the other four nutrition-related performance indicators were exceeded (Table 3). The EBBS found that the project contributed in increasing the knowledge of the beneficiaries on key infant and young child feeding practices from 35% at baseline to 100% at endline. This was achieved by using multiple channels at community and health facility levels to provide information and education on these practices. As shown 21 This was measured based on the AMEP definition of HHs reporting the practice of at least one of the nutrition behaviors promoted by the project. 16 in Table 3, the number of service delivery channels that mainstreamed appropriate nutrition messages were 822 at endline as compared to the project target of 5. The increased knowledge contributed to the adoption of some improved nutrition practices as already explained above. Other nutrition practices the increased knowledge contributed to its adoption were women dietary diversity (WDD) which increased from a mean of 3.7 at baseline to 4.3 at endline although the project target of 5 was missed; children receiving minimum acceptable diet (MAD) which also increased from 10% to 64.4%, 36.4 percentage points more than the target and exclusive breastfeeding which increased from 60% to 74.3%. Table 3: Performance of component 2 indicators Performance Indicator Baseline LoP targets BBS 2017 EBBS 2019 % of target achieved Component 2 Result: Improved behaviors related to nutrition and hygiene for women and children 1.2.1: % of households adopting improved nutrition practices N/A 85.0% 87.0% 100.0% 117.6 Intermediate Result 2a: Increased adoption of positive nutrition behaviors among target households 1.2.1.1: % of respondents in target communities knowledgeable of appropriate infant and young child feeding practice23 35.0% 60.0% 67.0% 100.0% 166.7 1.2.1.2: Number of service delivery channels that mainstream appropriate nutrition messages throughout the community 0 5 5 8 160.0 HL.9.1-c: Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age 3.7 5.0 N/A 4.3 86.0 HL.9.1-a Prevalence of children 6-23 months receiving a minimum acceptable diet 10.0% 28% N/A 64.4% 230.0 HL.9.1-b: Prevalence of exclusive breastfeeding of children under six months of age 60.0% 70.0% N/A 74.3% 106.1 Intermediate Result 2b: Increased adoption of hygiene and sanitation behaviors in target households and their communities HL.8.2-5: Percentage of households with soap and water at a handwashing station commonly used by family members N/A 30.0% 90.0% 81.7% 272.3 HL.8.2-6: Percentage of households in target areas practicing correct use of recommended household water treatment technologies N/A 40.0% 96.0% 98.8% 247.0 3.1.8.1-2: % of respondents who know any 3 critical times of hand washing 91.0% 95.0% 70.0% 82.5% 86.8 Further analysis of the MAD showed that 95.5% of the children met the minimum dietary diversity score; the proportion of children aged 6 to 23 months receiving food from four or more of the recommended seven food groups. However, the percentage of children meeting minimum meal frequency (66.3%) was lower than those who met the minimum dietary diversity score. 22 Channels: Mother-to-mother support group facilitator, Community Health Volunteers (CHVs), health workers/health facility, Agriculture Extension Agents, School Health Education Program Coordinators, Environmental Health Officers, Community Development Officers/social welfare officer and Radio presenter/ advert 23The Question for the measurement of this indicator was set as multiple response question which allowed respondents to select all options that apply. The options selected were used to calculate the indicator based on the AMEP definitions that any respondent who knew at least one IYCF practice was classified as being knowledgeable. 17 The performance related to improved hygiene and sanitation behaviors was also very good with the target of 2 of the indicators being exceeded by over 100% (Table 4). Nearly all HHs (98.8%) that use unimproved water sources used the project recommended HH water treatment technologies to make their water safer for drinking and other uses. This could contribute to reducing-water related diseases and overall morbidity of HH members. The EBBS found that the project had contributed to increasing the proportion of HHs with handwashing facilities near latrines from 4% at baseline to 34.5%. Out of the 34.5% with handwashing facilities, 81.7% had water and soap/ash at the handwashing station usually used by HH members. This was more than two times the project target of 30% although slightly lower than the 2017 BBS value of 90%. It is important to indicate that there was a slight difference in the 2017 BBS and EBBS methodology for measuring this indicator. While the 2017 BBS asked the question directly to the respondent, the EBBS was based on observation by data collectors. In terms of performance by the different types of HHs, 81.5% of female headed HHs had soap and water/ash at the handwashing station as compared to 75.8% for the male headed without adult female and 82.5% for the male headed with both adult male and female. The EBBS further found that 82.5% of the beneficiaries knew at least 3 critical times of hand washing. This figure however fell short of the project target of 95% and was also slightly lower than the baseline figure of 91%. Once again, male headed HHs without adult female (74.4%) performed relatively lower for this indicator as compared to other HH types that is 81.8% for female headed HHs and 83.9% for male headed with both adult male and female and 100% for child headed. Based on the above-reported sanitation knowledge and behavior results, it seems that women have a very important role to play in HH level sanitation activities and their presence in a HH is very important when it comes to handing HH sanitation issues. This could account for the trend observed in the hygiene and sanitation indicators among the different types of HHs. Question 1c: How has Global Communities RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). The indicators for component three of the project focused on measuring the participation of beneficiaries in project, the use of feedback from them in programming during the project implementation and the improvement in nutrition and livelihood services provided by local government institutions. All the implementing partners at the district level interviewed as part of the EBBS indicated they used feedback from beneficiaries in the planning and preparation of RING annual work plans (Table 4). The consultation and engagement at the area and zonal council level was one activity that was mentioned in all the districts as an opportunity to engage communities to get their needs and priorities for inclusion in the RING annual work plans. Decentralized units such as Community Development, the District Agriculture Development Unit and the District Health Directorate indicated that the implementation of project activities has helped them visit the communities regularly and they were better able to interact with communities and get feedback on activities which are then used to inform planning for future ones. As a key informant puts it, “Funds were available for outreach programs, there were also funds for office management and means of transport which enable us to increase coverage for services and visited the communities more often” (KII-DA West Gonja). 18 Table 4: Performance of component 3 indicators Performance Indicator Baseline LoP targets BBS 2017 EBBS 2019 % of target achieved Component 3 Result: Strengthened local support networks addressing the ongoing (nutrition and livelihoods) needs of vulnerable households 1.3.1: % of households reporting improvements in nutrition and livelihood services from local government24 N/A 80.0% 11.5% 100.0% 125.0 Intermediate Result 3a: Strengthened capacity of target DAs and the NRCC to respond to community priorities for improved nutrition and livelihoods 1.3.3.1: Percentage of core RING implementing departments that use community feedback to inform planning processes for their RING Annual Work Plans and Budgets and/or District Annual Action Plans N/A 80.0% N/A 100.0% 125.0 About 6 out of every 10 beneficiaries (60.3%) interviewed indicated that in the previous year a staff from District Assembly or one of the decentralized units engaged members of their community to plan on addressing their community’s challenges in health, agriculture, and WASH. Among those whose communities were engaged by the District Assembly and its units, 69.3% participated in the meeting. Figure 7: Changes in community engagement with District Assembly and its units in the last 2 years The beneficiaries who reported that there had been some engagement between their community and their District Assembly were asked to rate the changes in the engagement in the last 1 to 2 years. The majority (56.3%) indicated that there has not been any change, 30.5% indicated the engagement has increased; 8.4% decreased in engagement and 4.8% could not tell (figure 7). The use of community feedback is expected to help improve the services provided to beneficiaries. The EBBS found that the percentage of HHs reporting improvement in nutrition and livelihood services 24 This was measured using a multiple response for all HHs to select services that had recorded improvement. Any HH that report improvement in at least one services was added to the numerator as indicated in the AMEP definition of the indicator 30.5% 56.3% 8.4% 4.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Increased engagement No change Decreased engagement Don’t know /cant tell 19 from local government increased from 11.5% in 2017 (midline) to 10.0% at the endline. This improvement exceeded the project target by 25% (Table 4). Despite the improvement in engagement, most of the beneficiaries were not satisfied with the services provided to improve health and nutrition; agriculture and WASH (Table 5). Table 5: Satisfaction rating of services provided to improve health,, WASH and agriculture Rating Health and Nutrition Services WASH services Agriculture Services Frequency Percentage Frequency Percentage Frequency Percentage Very satisfied 10 1.2% 30 3.4% 23 2.5% Satisfied 25 2.8% 85 9.6% 56 6.3% Neutral 110 12.4% 132 14.9% 133 15.1% Dissatisfied 495 56.0% 449 50.8% 505 57.2% Very dissatisfied 243 27.6% 188 21.2% 167 18.9% Total 884 100.0% 884 100.0% 884 100.0% CONCLUSIONS QUESTION 1 Overall, it was observed that, there was a remarkable improvement in infant and young child feeding knowledge and practices among beneficiary households. There was also a dramatic improvement in hygiene-related practices among beneficiary households. The improvement in infant and young child feeding and hygiene practices could be attributed to the capacity empowerment of service providers and the increase in channels for receiving IYCF information. However, all these improvements in the area of practice and service provision contributed modestly to the gains in improving the nutritional status of children under five years in the beneficiary communities as there was only a slight reduction in severe stunting. They are however promising, and it is expected that in the medium term these improvements will translate into improved nutritional status. One factor contributing to the limited translation of the improved practices into improved nutritional status of CU5 the persistent food insecurity. RECOMMENDATIONS QUESTION 1  Sustained effort is required to get the improved IYCF and WASH knowledge coupled with the increased financial security of vulnerable HHs to translate into a reduction in malnutrition rates. These efforts will need to address HH food shortage and the use of extra income at the HH level. 4.3. QUESTION 2 WHAT UNINTENDED OUTCOMES HAS THE RING PROJECT’S LIVELIHOOD APPROACH AND ACTIVITIES ACHIEVED RELATIVE TO IMPROVING FARMER INCOMES AND REDUCING VULNERABILITY AT THE HOUSEHOLD LEVEL? Results from KII and FGDs revealed that there were a few positive unintended outcomes and no negative unintended outcome was identified. However, a few unintended results which might have limited project performance were identified. The positive unintended outcomes identified related to the promotion of cohesion among project stakeholders at different levels and increased social capital whilst the unintended results were related to delay in the release of funds and conflict in roles. These are discussed below. 20 The FGDs with the project beneficiaries revealed that the project had improved upon their social capital as the regular meetings of the VSLA brought about more social capital and social cohesion in their societies. Most of the members mentioned that the VSLA activity has brought unity and togetherness among the women of the community. It had also improved their confidence in speaking in public due to nutrition and health discussions sessions. The social capital and social cohesion are important in reducing vulnerabilities since the less privileged are catered for within the networks. As one of the participants in a FGD stated, “…now we have the confidence to speak in public and now we know and care more about each other” (Beneficiary FGD-Participant, Sagnarigu). The project implemented the VSLA component to increase access to financial services for beneficiaries through pooling of group resources and mobilizing savings. However, the cohesion among the VSLA groups and their ability to meet regularly, created an opportunity for other project interventions to be implemented through them. As a result, nutrition, health, and agriculture education were provided to communities through the VSLA groups. As FGD participants indicated, “…the groups that we formed at the VSLA service,....we form them purposely for savings … but those groups later on were used as the basis for other activities, because they are organized, Agric depended on them to carry out activities, health also came on board and use those groups …most of the activities were then hinged on, the VSLA that was formed. But here, the major purpose was to just for the savings activities, but they used them to implement other activities within the components...” (FGD￾DA, West Gonja) Like the cohesion reported among the beneficiaries, the project was also reported to promote cohesion among the units of the MMDAs and the departments of the NRCC. This was mainly attributed to the joint planning which enables the different units and departments to understand the activities of each other and to learn to work together in activity implementation. Some respondents in the KII and FGD put it as, “…my relationship with the departmental accountants and focal persons has improved as a result of the project. I now understand their roles and jobs better” (KII, A Deputy District Finance Officer) “Work planning session was very useful in getting all the stakeholders to understand what other departments were doing and experience sharing” (FGD, A Development Planning Officer, NRCC) "The District Gender Desk Officers are now close and working with the Department of Gender. They now share their reports with the Department, and I have a strong relationship with them. They call for resource materials" (KII, Regional Director, Department of Gender) The unintended results which could have affected project performance are discussed below. Delay in the release of funds from the USAID to the Assemblies and from Assemblies to decentralized units was seen to have limited project performance. Respondents indicated that some of their activities were unduly delayed due to the late release of funds to them by their MMDAs, which sometimes affected their effectiveness and efficiency. Some FGD participants put it as, 21 “Delay in release of funds from the USAID affected the implementation of project activities. Some activities like the agricultural ones are seasonal and when you miss the time and you proceed to implement, you are set to fail. Monitoring conduct by NRCC is on quarterly basis, if a quarter is passed it is passed; funds cannot be sent later and we will be asked to implement, are we going to conduct two visits in a quarter?” (FGD participant, NRCC) “I think one of the things I will say is the timely release of funds from RING to the Assembly. Sometimes … you plan maybe by this time you have finished implementing the activity, so because of the release of funds to implement intervention is always a challenge your plan will not work. When it comes to borehole repairs for now, we have prepared a plan to repair our boreholes, up till now we have not received items. The procurement person said he has prepared the documents, but is waiting for funds to be released to procure the borehole parts to enable us to repair the borehole that we are supposed to repair for this financial year but the monies are not coming....so we have to even wait, and as to when that money will be coming hhmmmm. Now, we are supposed to train pump caretakers, we submitted memos four months back, but there was no money; up till now no money. So it is a challenge that sometimes we must look at ....” (FGD-DA Staff, West Gonja) The delay in the release of funds in some situations was due to the delays on the part of the MMDA to retire funds already released to them by USAID. It was also indicated that although the project design was very good as it focused on government agencies to carry out implementation, making Global Communities responsible for results when funds were sent directly to the MMDAs was problematic and it led to some challenges. There was a strong push from Global Communities for results from the MMDAs which then led them to virtually taking over the role of the NRCC to monitor and supervise the assemblies. This created a conflict in the roles where the MMDAs sometimes did not know whether to go to Global Communities or NRCC when they need support. As noted by FGD participants, “Global Communities was responsible for results, but the assemblies were spending the money. The Assembly must be responsible for results so that they can be held accountable. Global Communities did not want to allow activities that will not provide immediate results for this reason.” (FGD, A Development Planning Officer, NRCC) "Global Communities had a lot of specialists and they ended up doing all the things the Regional Departments had to do to support the districts.” (FGD, A Development Planning Officer, NRCC) “By the design of the project, funds are given to the Districts directly and Global Communities is accountable for results. Global Communities cannot control the districts, it is difficult to ensure that the right things are done. For example, the quality of some of the training in some districts were questionable. Three days of training conducted in one day. We could not stop them, so we asked them to always share training schedules [in advance].” (KII, Global Communities Project Staff) The views on the role of Global Communities was however mixed, as discussed in the lessons learned section. Some district officers indicated that the staff from some of the Regional Departments were not very responsive when they reached out for support hence, they had to resort to technical specialists at Global Communities. One reason that could have accounted for this is that Global 22 Communities had more resources and staff and were able to move within short notice to support districts as compared to the NRCC departments. Access to resources from NRCC was slow. At the district assembly level, it was found that some decentralized units had to rely on Global Communities Governance Advisors to engage District Coordinating Directors, Planning Officers and Chief Executives to facilitate the early release of funds for the implementation of project activities. The government structure does not provide opportunities for the decentralized units to get this type of support. In those districts, the role of the Advisors was seen to be central to the timely implementation of project activities and achievement of results. As indicated in a FGD, "Sometimes we send request for funds and it takes a very long time to get approval. We must do a lot of follow -up. Once we inform the Governance Advisor, she can follow-up for us. Anytime she gets involved the money is released immediately" (FGD, DA Staff, Kumbungu). One challenge of the livelihood approach was the perception among some stakeholders that giving the beneficiaries inputs, animals and other support free made some of them less responsible as they did not show any commitment to the interventions. As was reported by some key informants, “The project design did not allow any sense of ownership from the beneficiaries because everything was free, free and free. No commitment from them.” (KII, Regional Agriculture Directorate) “When you visit some of the beneficiaries, they tell you that your animals are missing, we could not control the weeds on our farm….” (KII, Global Communities Project Staff) CONCLUSIONS QUESTION 2 Unintended results such as the promotion of cohesion and understanding of each other's work among departments of the NRCC and decentralized units of the MMDAs might have helped in improving project’s activity implementation. Similarly, the cohesion and improvement of social capital coupled with improved savings and access to credit through VSLA contributed to improving the achievement of project results. The challenges might have limited the achievement of project results. The inability of some stakeholder to understand the roles of NRCC and Global Communities limited the benefits such stakeholders could have derived from complementary roles of the two organizations. Delays in the release of funds at whatever level and for whatever reason limited the effectiveness of activity implementation and hence affect project results. RECOMMENDATIONS QUESTION 2  Future projects should continue to create avenues for joint planning and review among units of the District Assemblies and Departments of the NRCC. It should also explore other opportunities to promote cohesion and to get units and departments to move from joint planning to joint implementation. 23  Mechanisms should be put in place as part of future projects to have buffer funds for use to implement activities that are very time-dependent, whilst working at addressing delayed funds release at the different stages.  On the side of the MMDAs, future projects should include measures on funds release to units as a key performance indicator.  Sending funds to MMDAs directly helps to strengthen the decentralization system and should be continued. However, future projects should make MMDAs responsible for their results or give contractors some authority to hold MMDAs accountable for results. 4.4. QUESTION 3 WHAT CAN BE IDENTIFIED AS LESSONS LEARNED AND BEST PRACTICES AND FROM WHICH STAKEHOLDERS OR BENEFICIARIES? (EFFECTIVENESS)? So many lessons worthy of sharing were observed in the field from the perspectives of the different project stakeholders. Not allowing communities and beneficiaries to select interventions may have limited benefits: Stakeholders at the regional, district and community levels were of the view that the effectiveness of the interventions was reduced by not allowing communities to select the interventions they were interested in. For example, in the case of the small ruminants, they were of the view that beneficiaries should have had options of different animals to choose from depending on the prevailing conditions in their communities. “The small ruminant intervention should have had options for the beneficiary to choose. That is both sheep and goats so that beneficiary depending on the conditions prevailing in their communities could choose to real sheep or goats” (FGD, Development Planning Officer, NRCC) "we would have liked goat because they multiply fast, but we were given sheep. They did not ask which one we like" (FGD, Beneficiary, East Mamprusi) Beneficiaries in one community were given OFSP vines and they had no land to cultivate it because none of them was a farmer. In a beneficiary FGD, a participant stated, “…if they can let us choose the intervention we want, it will help us. They brought us orange flesh sweet potato vines, but we are not farmers, and we don’t also have land. The vines also came late, and we could not do anything with it. So, if they can let us choose the support, we want it will be good” (FGD, beneficiary, Savelugu Nanton). By the project design, the districts could select the interventions to implement in their areas from the activity menu25, however, the districts did not allow communities to select interventions as discussed above and this might have limited the benefits of the interventions. 25 The Activity menu was a list of activities/interventions agreed between USAID, Global Communities, the MMDAs and the NRCC. The MMDAs were to select only activities from this menu for inclusion in their annual work plans. The menu was adjusted from time to time based on experience implementing the activities and consultations among the stakeholders. For example, activities seen not to be effective were removed based on agreement among all stakeholders. 24 Politicians may manipulate the beneficiary and intervention allocation process: District and community level stakeholders complained about the allocation of interventions to beneficiaries being influenced by community-level politicians and the District Chief Executives. This complaint was mostly related to the small ruminants' intervention, where beneficiaries complained of preference being given to people perceived to be members of the ruling government when it comes to giving the animals. This might have led to beneficiaries not qualified for some interventions receiving it, hence reducing the project effectiveness. Some best practices identified are discussed below Effective community engagement is key to project success: Community engagement contributed in enhancing the project effectiveness. Stakeholders at District Assembly and community level noted that community engagement is so valuable in driving home change in the community. This was evident in the excerpt of the qualitative transcript below “The more you engage communities the more you are likely to succeed so we learned that to bring about positive change in the communities, community involvement and participation are key" (FGD￾DA, West Gonja). Use of multiple channels to provide behavior change communication information ensured beneficiaries increased access to information: The use of several channels such as health facilities, VSLA meetings, radio, schools, meetings with Agric Extension Agents etc to provide infant and young child feeding and WASH information ensured that beneficiaries had constant access to information, and this contributed in increasing their knowledge. VSLA remains an effective avenue for delivering information to community members: It was so easy to deliver key information on critical health, nutrition, and WASH to community members using the VSLA platform and no extra resources were needed to mobilize the women. Joint planning and review promote collaboration among departments and units: The joint planning and review was seen to promote cohesion and collaboration among units and departments at the District Assembly and NRCC levels respectively. This also promoted experience sharing and learning. Competition among districts promote performance: The rollout of the District open defecation league table where districts were ranked based on their sanitation and hygiene improvements in their communities, got districts to be very serious about dealing with open defecation. It was central in getting district-level leadership to develop an interest in dealing with open defecation. CONCLUSIONS QUESTION 3 Lessons such as the use of multiple channels to enhance information provision and VSLA as an opportunity to deliver critical health, nutrition and WASH information were identified and used during the project implementation to enhance project results. The role of competition in enhancing performance was also identified and used by the project. The potential of politicians to influence the allocation of interventions to selected beneficiaries was not identified and addressed by the project so it might have limited project results to a very little 25 extent. Similarly, the effect of not allowing communities and beneficiaries to select interventions of interest on project performance was not identified during the project implementation, therefore no steps were taken to allow it to happen or to mitigate any limiting effect it might have on project results. Future projects of this nature can consider these lessons in terms of design and implementation to enhance its effectiveness. RECOMMENDATIONS QUESTION 3  Future interventions should consider developing a menu of activities for communities to select from. The lessons from that will then be useful in deciding whether to allow beneficiaries to select their interventions of interest.  The use of multiple communication channels should be continued by future interventions.  Lessons learned from the implementation of this project should be shared with managers and staff of future projects  The use of VSLA as a platform for the delivery of key messages should be promoted in future projects. However, care should be taken to limit how these groups are used in promoting key message so the fundamentals of establishing the groups are maintained. 4.5. QUESTION 4 TO WHAT EXTENT ARE THE RING INTERVENTIONS LIKELY TO CONTINUE AFTER USG SUPPORT? IS STAKEHOLDER BUY-IN LIKELY TO CONTINUE OR BE INCREASED AFTER THE CURRENT PROJECT EXPIRES? (SUSTAINABILITY) The sustainability of the project activities was examined from the perspective of beneficiaries being able to continue interventions, such as cultivating soybeans, OFSP, VSLA and small ruminants and the ability of MMDAs and its decentralized units to continue to provide support to existing beneficiaries and/or get more vulnerable HHs to benefit from interventions. It was generally observed that beneficiaries would be able to continue the livelihood activities after the RING support has ended. The most promising ones according to the stakeholders included the VSLA as it may require less effort to keep it running. Almost all the beneficiaries (99.3%) indicated they will continue their VSLA activities after the RING project has ended (figure 8). The excerpts from the qualitative transcript below supported the above observation. “The VSLA has the higher potential to be sustainable. The reason is that the women are willing and already attempted in the past to do some form of saving. It is evident in the community that even those who are not beneficiary of VSLA emulate the members of VSLA by having regular meetings to also do some form of savings." (FGD-DA West Gonja) 26 Figure 8: Beneficiaries who indicated they would continue interventions after RING support has ended As shown in figure 8, the findings from the HH survey shows that 91.8% of beneficiaries reported they would continue to grow OFSP after the RING support has ended (figure 8). In terms of sources of vines after the project has ended 26.2% indicated they would preserve their vines; 19.3% would obtain vines from vine seller; 17.6% from their friends; 37% from extension officers and the remaining 21.8% from other sources. Whilst the results from the beneficiaries shows a clear interest in continuing to grow OFSP, the stakeholders at the Regional level and in some districts thought there was little chance of the beneficiaries continuing the activity. They were of the view that it could not be stored for a long time and beneficiaries might not obtain the vines after the project is finished. To them, the prices of the vines from the vine multipliers could not be controlled beyond the project and this might limit the beneficiary's ability to purchase the vines. Discussion with Global Communities however indicates that the beneficiaries were engaged on how to preserve their vine. However, the HH level vine preservation had challenges because of the need for water. To address this, the project supported the establishment of vine multiplication centers in all the districts. The explanation from Global Communities reflects in the sources of vines as indicated by the beneficiaries and discussed earlier. Whilst soybeans did not feature in the FGDs and KII interviews as one of the activities which can be sustained, a large majority of the beneficiaries (89.3%) indicated they will continue to farm soybeans after the RING support has ended. The small ruminant intervention was also seen as one that the beneficiaries can continue beyond the project. Their main reason was that animal rearing was part and parcel of almost all communities in Northern Ghana, although new to the majority of the beneficiaries (88.8% had their first small ruminant rearing experience through RING). The unique thing about the small ruminant intervention was that it targeted women who in some settings were not allowed to rear animals and placed emphasis on housing and the use of veterinary services. Vegetable cultivation according to the stakeholders is not also new in the beneficiary communities. Therefore, beneficiaries require less effort to sustain these interventions as observed during the discussions with the stakeholders as shown below “High potential for sustainability …. Leafy green vegetable cultivation, rearing of small ruminant and VSLA are that I believe have the high potential of been effective. There is no household in the communities that do not rear small ruminant and so it is something that they do. The only thing they may need to continue rearing is technical support especially when the animals are sick which the Agric 91.8% 89.3% 99.3% 82.0% 84.0% 86.0% 88.0% 90.0% 92.0% 94.0% 96.0% 98.0% 100.0% OFSP Soy beans VSLA 27 department can continue to provide even after the project Through rearing of small ruminant, the beneficiaries can get extra income which they can save in the VSLA or even invest and save the profit in the VSLA, and from the VSLA savings they can get new stock of animals and continue to rear. So, these two programs can support each other and be sustained in the communities” (KII-DA Savelugu Nanton) The nutrition activities especially those related to the provision of nutrition information and counseling are also intervention that can continue albeit on a low scale and at health facility level since the government is unable to provide fuel for outreach. Activities such as food demonstration also has a chance of continuing if the health workers let the community members provide the foodstuff need for the activity. Findings of the FGD with MMDA staff indicated that some districts had already started the process of letting the beneficiaries provide food items for food demonstration sessions. The mother to mother support groups (MTMSGs) had a similar potential as the VSLA since the two were even integrated in several communities. WASH activities in the area of constructing latrines and handwashing stations also have some chance of being sustained because the focus was on the use of local material and beneficiaries were given the skills to construct it on their own. The beneficiaries would therefore be able to maintain and replace latrines and handwashing stations that develop problems. On the ability of MMDAs to continue to provide support to beneficiaries for these activities after the project has ended, it was observed that the project had laid a good foundation for that through capacity building and logistics such as motorbikes. This means human resources and logistics exist in all the decentralized units of the MMDAs to continue activities if the MMDAs can provide consumables and fuel. The MMDAs will however not have the resources to continue to implement the small ruminants' intervention by providing other vulnerable HHs with animals, because the intervention was very expensive. Sub-components such as veterinary extension services and some of the community livestock workers do have the potential to continue since it requires minimal funding and beneficiaries may gradually be able to pay some meagre amount of money for their services. The WASH interventions26 that had the least chance of being sustained after RING support were already identified during the project implementation and stopped. These are the provision of aqua tabs for water purification and filter pots and the construction of rainwater harvesting facilities. The community lead total sanitation (CLTS) component can, however, continue because it requires limited investment and there were community members empowered to lead the process. So, they can still do most of the work with minimal support. The MMDAs can continue to expand VSLA and OFSP activities because they require very low capital investment in the form of fuel for the MMDA staff whose capacity has been built by the project to visit communities and mobilize them for the activity to take off. In the case of OFSP some vines will be required. Capacity building for new beneficiaries can be carried out at the community level. 26 Aqua tabs for water purification, filter pots and the construction of rainwater harvesting facilities. 28 The joint planning and development of annual report session was one RING activity the MMDAs and the NRCC staff indicated can be easily adjusted and adopted as part of the annual budgeting process of the government. CONCLUSIONS QUESTION 4 The findings show a clear buy-in from the beneficiaries, hence their willingness to continue activities after the project has ended. It was generally observed that some of the interventions had a natural tendency of being continued by the beneficiaries after the RING support with little or no support from the MMDAs. The VSLA is a star intervention which could be sustained with little effort from community members. It can also serve as support to enhance the sustainability of other activities and make the mobilization of beneficiaries easy. The OFSP is the other activity with great potential because beneficiaries can get the vines in their communities. The other is MTMSGs because it is integrated with VSLA. The nutrition￾related activities and interventions had a high chance of being continued because they were less capital intensive and are part of the core interventions of the Regional and District Health Directorates. The rearing of small ruminants has potential although not like the others. Its sustainability will require the provision of critical services such as para vet. The MMDAs would not be able to have new beneficiaries in small ruminants and soybeans. However, for VSLA, OFSP and nutrition outreach they could easily do that through providing fuel for field activities. RECOMMENDATIONS QUESTION 4  MMDAs should focus on providing fuel support to decentralized agencies to continue to provide regular support to beneficiaries especially the VSLA and MTMSGs and explore how they could use it to sustain other interventions.  The MMDAs and the NRCC should adopt the joint planning session and use it for the annual government planning and budgeting process. This will ensure that the units and departments continue to have an opportunity to engage and share lessons.  Community members should be made to provide food items for the food demonstration activities.  In future projects, the MMDAs should be tasked to take over and fund some project activities during the life of the project. This can be factored in as a performance measure and tied to continued funding under the project. 29 4.6. QUESTION 5 WHICH RING INTERVENTIONS ARE THE MOST EFFECTIVE AND LEAST EFFECTIVE AT IMPROVING LIVELIHOODS, NUTRITIONAL STATUS, AND HYGIENE PRACTICES? (EFFICIENCY AND EFFECTIVENESS) It was observed from the KII and FGDs discussions that several interventions were considered effective by both project beneficiaries and stakeholders. This was supported by the data from the HH survey. The VSLA program was seen by many as the ‘star intervention' as it was considered effective in improving livelihood, nutrition, and even a platform to promote hygienic practices in the beneficiary communities. This observation is supported by the excerpts of the qualitative transcript below; “We used to belong to a credit union in this group, it was very difficult to pay for loans because of the interest but when we joined the VSLA it has improved upon our lives and HH income. I take a loan to assist in my farm. It has also improved upon our family’s nutritional status and hygiene because I sell the farm produce to buy things like fish to add to soup” (FGD Beneficiary-Karaga). “VSLA in beneficiary communities has created a lot of businesses, as people borrow money and start petty trading and farming. Saving capacity of the beneficiaries has increased. Some beneficiaries have also acquired lands through their saving with VSLA” (KII-DA Savelegu Nanton) The nutrition interventions focused on improving infant and young child feeding knowledge and practices among the beneficiaries was also quite effective since the target of most of the infant and young child feeding knowledge and practice indicators were met. For the WASH interventions, the distribution of the ceramic filters and aqua tabs and the construction of water harvesting facilities for HHs were seen to be the least effective. These interventions were quite expensive and delivered little value, as a result, they were even removed from the menu of activities. The most effective WASH intervention was the CLTS. To look at the potential of the interventions to improve nutrition and hygiene and other indicators, an analysis was carried out for HHs that benefited from only single interventions. This analysis first looked at only HHs that benefited from single interventions and then looked at the effect of getting multiple interventions. The ability to conclude on this is however limited because there was no baseline about these HHs or even any data from the 2017 BBSs to compare. The results as shown in table 6 indicated that the proportion of LGV only beneficiaries who reported increase/more diversified (86.4%) was the highest followed by OFSP only (74.3%); small ruminants only (73.2%) and VSLA (63.9%). For HH financially security, LGV only beneficiaries had the highest proportion and OFSP only the lowest. All LGV only and OFSP only beneficiaries had a handwashing facility with soap in their HHs with that of VSLA being 83.8%, soybean 80.4%, and 62.5%. Overall there seem not to have been much difference in the performance of the indicators among the different beneficiary groups. 30 Table 6: Performance of selected indicators among HH that benefited from single intervention Intervention Handwashing facility with soap/ash Financially secured HHs % with increased/ more diversified income as a result of RING % reporting shorted lean season VSLA only 83.8% 60.8% 63.9 77.9 Small ruminants only 62.5% 69.0% 73.2 76.1 LGV only 100.0%* 68.2% 86.4 63.6 Soya beans only 80.4% 68.2% 63.6 66.7 OFSP only 100.0%* 51.4% 74.3 88.6 *Very small sample size The results of the key indicators by the number of interventions a HH received are shown in table 7. The results did not show any clear trend that increasing the number of interventions a HH benefited from would shorten the period it experiences lean season or increased the practice of exclusive breastfeeding. Similarly, HH financial security did not show any trend with an increasing number of interventions. However, for HHs reporting they now have increased/diversified income sources as a result of RING intervention and the availability of handwashing facility with soap, there was a clear trend. As the number of interventions per HH increased the proportion that had increased/more diversified income sources increase. Similarly, as the number of interventions increases the proportion with handwashing facility with soap/ash increases but does not increase further when more interventions are added after the third one. Table 7: Number of interventions HH benefitted from and performance in key indicators # of interventions HH received from Exclusive breastfeeding rate Financially secured HHs % with increased/ more diversified income as a result of RING % reporting shorter lean season HHs with handwashing facility with soap/ash 1 61.7% 62.0% 67.1 77.3 80.4% 2 77.5% 65.6% 74.6 78.3 81.4% 3 74.7% 78.8% 74.6 72.9 90.2% 4 72.2% 77.2% 84.9 75.0 90.2% 5 86.8% 77.2% 90.7 75.0 90.2% CONCLUSIONS QUESTION 5 The project was quite successful in identifying and stopping ineffective and inefficient interventions which helped in improving the effectiveness and efficiency of the project. It was not possible to tell which single interventions were effective than the other. However, the results suggested that supporting HHs with more than one intervention (layering of interventions) could be effective and help them to improve their resilience faster. 31 RECOMMENDATIONS QUESTION 5  USAID should continue to allow some flexibility for future projects to be able to discontinue activities that are found to be ineffective and inefficient during project implementation  Nutrition information and counselling interventions are effective in increasing knowledge on infant and young child feeding, however, a lot more is needed to move the increased knowledge to practices that will reflect on the nutritional status of children.  The layering of interventions should be promoted as part of all projects targeting the poor and vulnerable 4.7. DECISION MAKING ON SALE AND USE OF INCOME FROM LIVELIHOOD INTERVENTIONS The EBBS also looked at decision making with respect to key RING interventions as it related to the sale and use of money from the sale of items from livelihood interventions (Table 8). In response to who makes decisions when it comes to taking VSLA loans, 78.9% of the beneficiaries as compared to73% in 2017 BBS said they do the decision making all by themselves. This was followed by those who take the decision together with their husbands (15.0% compared to 22% in 2017) and those who take decisions with others such as children (1.9% compared to 0.1% in 2017). Whilst there was no baseline to compare with, the results of the 2017 BBS and the endline findings show an improvement in the autonomy of women when it comes to decision making to access a loan from the VSLA. Results from the decision making concerning the sale of small ruminants, however, had an interesting trend. The percentage of beneficiaries who decided to sell by themselves decreased slightly from 44% in 2017 BBS to 41.2% in 2019. Interestingly the beneficiaries whose husbands decided on the sell reduced from 18% to 15.9% a positive trend over the same period. The findings seem to suggest that more women were involving their husbands in decision making on the sale of small ruminants (37.5% in 2017; 39.7% in 2019) hence the reduction in those who decided on their own. Half a percentage of the beneficiaries made the decision to sell with other family members in 2017 as compared to 3.3% in 2019. The husbands might have had a bigger role in the decision to sell small ruminants as compared to taking a VSLA loan because they are more likely to support the women in the rearing of small ruminants. It was further observed that the project had contributed to addressing myths in relation to women rearing small ruminants in several of the project communities. Women were hitherto not allowed to rear animals (small ruminants) but the small ruminant component of the project changed this perception and a lot more women in the communities are now venturing into animal rearing. In the focus group discussions, participants indicated that, “RING has helped to change the perception that women can’t own livestock. Which is a good thing for women empowerment; the intervention has broken the culture of women not being allowed to own animals” (FGD-DA Staff, Kumbungu); 32 “The women are now highly sensitized. The traditional roles of women have been modified as they could not rear animals but with the implementation of the intervention particularly the small ruminant women now realize they can also rear animals. Through the sensitization given, women could tell the signs of a sick animal” (FGD-DA Staff, Savelugu Nanton) Table 8: Decision making on the sale and use of proceeds from soybeans and leafy green vegetables Decision maker Who makes decisions when it comes to taking a VSLA loan? Who makes decisions when it comes to the sales of your small ruminants? % of respondents (2017BBS) % of respondents (2019EBBS) % of respondents (2017BBS) % of respondents (2019EBBS) Self 73% 78.90% 44% 41.20% Husband 5% 4.20% 18% 15.90% Husband and I 22% 15.00% 37.50% 39.70% Others 0.10% 1.90% 0.50% 3.30% Who makes decisions when it comes to the sales of your soybeans? Who decided on how to spend the income earned from soybeans? Self 45% 55.40% 41% 50.90% Husband 6.50% 6.70% 7.70% 7.50% Husband and I 47.60% 36.10% 51% 40.30% Others 0.90% 1.70% 0.30% 1.30% Who makes decisions when it comes to the sales of your LGV? Who decided on how to spend the income earned from OFSP? Self 75.40% 72.90% 58% 75.60% Husband 3.40% 3.10% 1.80% 4.50% Husband and I 16.00% 17.80% 38.40% 7.70% Others 5.10% 6.30% 1.80% 12.20% Table 8 shows the results for decision making on the sale and use of proceeds from soybeans and LVGs for 2017 BBS and the EBBS. Like the small ruminants' intervention, women autonomy in terms of deciding to sell soybeans (45% to 55.4%) and on the use of the income from the sales (41% to 50.9%) increased between the 2017 BBS and the 2019 EBBS. This increase was due largely to a reduction in the proportion of women who makes decisions with their husbands. In the case of LGV, women's autonomy in deciding to sell recorded a marginal reduction from 75.4% to 72.9%. For OFSP beneficiaries, the focus was on the decision making concerning how the income from the sale was spent (Table 8). The results once again showed an increasing autonomy of women. In 2019, 75.6% of the beneficiaries made the decisions on the use of the income from the sale of OFSP by themselves as compared to 58% in 2017. The percentage who decided with their husband increased from 1.8% in 2017 to 4.5% whilst joint decision making with husband dropped from 38.4% to 7.7% and husband only decision making increased from 1.8% to 4.5%. 33 CONCLUSIONS ON DECISION MAKING The findings show that the project contributed to improve the women's autonomy in decision making on the sale and use of income from livelihood interventions for all interventions. This is quite some good outcome and justifies the decision to target women with these interventions. RECOMMENDATION ON DECISION MAKING Future projects should continue to target vulnerable women with interventions in order to improve their autonomy not only in the control of the benefits coming directly from the intervention but also to get increase their participation in HH decision making especially as it relates to the control and use of HH resources. 4.8. INTERVENTION SPECIFIC RESULTS This sub-section describes the EBBS report for the results for the livelihood interventions. The tables are shown in Annex IX. Village Savings and Loans Association (VSLA) Beneficiaries most commonly got money from petty trading, i.e. income from their small businesses (47.1%), to invest in the VSLA. Some others also got money from crop production (34.5%) as well as processing (23.8%) to invest in the VSLA. The majority of beneficiaries indicated that their income was better (53.3%) than that of the previous year. Beneficiaries most commonly used the moneys they derived from the VSLA investment to buy food for their family (43.1%), pay school fees for their children (20.9%), pay health-related costs (20.2%), among other domestic expenditures. On challenges encountered as VSLA beneficiaries, while almost half of them said they had not encountered any challenges, some 44.7% indicated a lack of income to save (44.7%) to be their challenge. Others mentioned group dynamics (9.2%) and lack of time to attend meetings (7.2%), among others. Majority of the beneficiaries (55.8%) took loans ranging from GHS 70 to GHS200 to pay health-related costs (29.3%), pay school fees for their children (22.7%) and buy food for their respective families (20.5%), among others, while some others also used the loans, they took to start income-generating activities (19.0%). Indeed, beneficiaries unanimously responded in the affirmative (99.3%) when asked whether they would continue to be VSLA members after this cycle of savings. Small Ruminants’ In all, 1,900 small ruminants were given out to the 631 beneficiaries interviewed. Over the period, 1,959 live births were recorded with 1,351 deaths, and 321 sick animals. Furthermore, a total of 447 small ruminants were sold by the beneficiaries, yielding a total amount of GHs 52,957.35 (at an average price of GHs 120.71). A total of 97 ruminants were either stolen or got missing and could not be retrieved, while 23 in total were slaughtered for sacrifice and currently, 1905 ruminants were available. An indication of how much benefit has been derived from the RING intervention, by the beneficiaries, is seen in the fact that about 81% of beneficiaries reared ruminants for the first time through this intervention while an average of two ruminants was sold by the beneficiaries, yielding an average of GHs 249.52. The most common reason cited for selling the animals was sickness (23.1%) followed by 34 paying of school fees (22.0%), buy food for family (20.8%), pay health-related cost (12.1%), buying farm inputs (7.5%), in that order, among many other reasons. The commonest housing for the ruminants was pen constructed with mud (66.9%) followed by pen constructed with straw (13.3%) and some 12.7% of them were kept in abandoned rooms. Almost 47% of respondent households used animal droppings as manure for further agricultural activities. Soybean About 24.1% of the total beneficiaries were into soybean farming. Of that proportion, 40.9% were already into soybean farming before the inception of RING. However, 77.7% of the soybean farming beneficiaries got their land for the soybean farming from their respective husbands while some 9% had theirs from other household members. The total land area under soybean cultivation by the respondents was 315.7 acres with an average of an acre per beneficiary, while the quantity of soybean harvested in total was 71,009.5 kg (average of 224.9kg per acre) with an average of 221.9 kg per beneficiary. A little over 65% of soybean beneficiaries sold part of their produce while all of them set some aside for home consumption. Beneficiaries had soybeans in their homes for use for a period ranging from one month (6.0%) to 7 months and above (30.9%). Orange Fleshed Sweet Potatoes (OFSP) A total of 1,365 (making 64.5%) respondents benefitted from the OFSP intervention. Every district benefitted from the OFSP intervention, though the number of beneficiaries varied per district, ranging from 16 beneficiaries (West Gonja) to 124 beneficiaries among the respondents (Karaga District). A total of 8,602,010 vines were planted (ranging from 44,406 in Karaga to 2,143,526 in Saboba District) yielding a total of 1,991,285.40kg of OFSP, an average of 2,278.1kg per district. The quantity of OFSP sold by the beneficiary was 14,203.2kg amounting to GHs 5,564.43. Almost all (91.8%) the beneficiaries interviewed responded in the affirmative when asked whether they would continue to grow OFSP. When asked where they would get the vines to plant the next time, they wanted to grow the OFSP, some of the responses given were that they would source vines from agriculture extension officer (37.0%), preserve vines from own farm for next season (26.2%), buy from a vine seller in the community (19.3%). Leafy Green Vegetable (LGV) A total of 320 (15.1%) respondents benefitted from the growing of Leafy Green Vegetables (LGVs) and the types of LGVs grown were Biraa (91.5%), Ayoyo (88.6%) and Aleefu (49.1%) among others. Most respondents (32.8%) reported they had access to LGVs for between six to twelve months in a year while less than ten percent (8.9%) reported to have access to LGVs for only a month. A little over ten percent (10.3%) of the respondents reported they had access to LGVs for up to five months in a year. Almost half of the LGV beneficiaries (47.7%) have ever had their drip irrigation equipment broken down before, over the period while most of those who had that experience (63.5%) were able to fix their irrigation equipment. The commonest places they obtained water for the irrigation of the LGV farms were streams (46.8%), rivers (21.8%), dams (12.2%) and boreholes (7.9%) in that order, among other sources. About 37% of the LGV respondents indicated that water does run out during the dry season. 35 On volume of LGVs harvested, 278 out of the 320 households that were interviewed who happened to be male-headed, with both male and female adults, harvested a total of 21,318.84 kg of LGVs, a mean of 76.8kg per household in the just-ended season. The majority of what was harvested (18,098.18 kg) was used for home consumption at an average of 65.22 kg per male headed household. They sold a total of 13,432.15 kg of LGV among others. The beneficiaries commonly sold the LGVs to start an income-generating activity (48.9%), followed by paying school fees for their children (27.4%) and pay health-related costs (16.0%) in that order, among other uses. The commonest place they sold their LGVs is neighboring community markets (42.2%), in their village markets (40.3%) and at home (33.6%) in that order, among other places. 4.9. OVERALL CONCLUSIONS Empirical evidence from the survey supports the development hypothesis that strengthening local networks (i.e. district and regional structures) to develop, implement and monitor nutrition, WASH, and livelihoods activities would improve beneficiary nutrition and hygiene behaviors, which, in turn, would improve the nutrition and health status of women of reproductive age and children under five in targeted vulnerable households. Project interventions (small ruminants, OFSP, LGV, VLSA, WASH, Soybean) improved access to, and consumption of diverse quality food among target households, especially among women and children under 5 years. However, the results are yet to translate into significant improvement in the nutrition status of CU5 as stunting, underweight and wasting rates remains unacceptably high. The project has improved behaviors of beneficiary households related to nutrition & hygiene for women & children through the interventions implemented. The use of multiple channels and provided a platform (e.g. VSLAs and VSLAs converted into Mother to Mother Support Groups) for beneficiaries to be educated on proper nutrition and hygiene for women and children as well as enhanced the financial capacity to make the necessary changes through the income-generating activities. The project has also strengthened local support networks (MMDA structures) addressing nutrition and livelihoods needs of vulnerable households. Direct support to district assemblies have enhanced their capacities to deliver on their mandates in the areas of nutrition, WASH and livelihoods. This was seen both in the technical capacity of decentralized units of the assembly to deliver and in enhanced logistical support. Whilst the outcomes of the RING interventions were positive, there is a challenge to the ability of MMDAs to sustain the interventions after the exit of RING due to the funding gap in the operations. They do have the potential to manage and continue to provide support to interventions such as the VSLA, OFSP, and CLTS because those require very little cost. The potential for sustainability is however higher at the beneficiary level for VSLA, OFSP, and small ruminant interventions because of the commitment of the beneficiaries and support available at the community level. 36 ANNEXES ANNEX I: EBBS STATEMENT OF WORK I. PURPOSE OF THE END LINE BENEFICIARY-BASED SURVEY The purpose of the end line beneficiary-based survey (EBBS) is to satisfy the monitoring and reporting needs of the RING Project by providing data to gauge the performance of 18 survey-related indicators in the RING Project’s Activity Monitoring and Evaluation Plan (AMEP). Specifically, the EBBS will provide data for: (1) reporting on performance of the 18 survey-based indicators; (2) estimate changes in outcomes and outputs since baseline; and (3) determine the effectiveness of activity management strategies for key interventions within the agriculture, livelihoods, nutrition, good governance, and water access, sanitation and hygiene (WASH) components of the RING Project. The findings of the EBBS will inform the project partners (USAID/Ghana, Global Communities RING and the target District Assemblies and the Regional Coordinating Council – RCC) about which of the project interventions have worked well and why, which perhaps have not and why. The information provided will be used to inform post-project scale up of most promising RING activities and to inform future design of similar projects by USAID and its partners. 1. Audience and Intended Uses The results of the EBBS will be useful for a variety of actors in the USAID/Ghana Mission and its partners because of the interest in the RING Project implementation approach of G2G programming. The results will directly be used by the following key actors: ● USAID/Ghana Mission Program Office to inform broad strategy during the development of the new Country Development Cooperation Strategy (CDCS); ● The Health, Nutrition and Population Office (HPNO) and the Economic Growth Office (EGO) to inform the development of the Project Appraisal Document (PAD) for the health and nutrition aspect of the Feed the Future Phase II programming in Ghana; ● Global Communities RING to inform performance measurement of the 18 survey-related indicators, as well as meet the end of project reporting requirements of the RING project; ● The RING Project Metropolitan, Municipal and District Assemblies (MMDA) and Northern Regional Coordinating Council (NRCC) partners to inform changes in outcomes of the RING interventions and to guide future livelihood enhancing interventions. II. SUMMARY INFORMATION The Resiliency in Northern Ghana (RING) project is a US$60 million USAID/Ghana-funded five-year integrated project that contributes to the Government of Ghana’s (GOG) and the U.S. Government Feed the Future Initiative’s efforts to sustainably reduce poverty and malnutrition. The project aims to improve the livelihoods and nutritional status of vulnerable households in partnering districts in the most food-insecure parts of the Northern Region. The RING Project’s interventions are implemented through 17 MMDAs and the NRCC, along with technical assistance from Global Communities Inc., a U.S. based non-governmental organization (NGO). 37 Table 1 Project Identification Data Strategy/Project/Activity Name Resiliency in Northern Ghana (RING) Project Technical Assistance Contractor Global Communities (GC) Contract # AID-641-C-14-00002 Total Estimated Ceiling of the Evaluated Project/Activity(TEC) $60 million Life of Strategy, Project, or Activity June 14, 2014 – September 30, 2019 Active Geographic Regions 17 Metropolitan, Municipal and Districts Assemblies within Northern Region Development Objective(s) (DOs) Development Objective: USAID/Ghana’s Development Objective 2 (DO.2): Broadly Shared Economic Growth, Intermediate Result (IR) 2.3: Improved Resiliency of Vulnerable Households and Reduced Under-Nutrition (Ref. FTF IR 2) III. BACKGROUND  Description of the Problem, Context and History Despite the fact that Ghana’s economy grew roughly 7% on average between 2005 and 201527, inequality has been increasing in the country and poverty remains prevalent in many areas. The Resiliency in Northern Ghana (RING) Project was developed to improve livelihoods and nutritional status of populations in Northern Region, Ghana, which experiences the highest and most persistent rates of poverty and food insecurity in the country. Today, the Northern Region comprises the largest number of poor people of any of Ghana’s ten regions (i.e. 1.3 million people).28 Of particular concern is persistent food insecurity and malnutrition, of which 453,000 people are considered food insecure. The Northern Region also has the highest rates of stunting in the country: roughly 33% of children under 5-years-old are stunted or chronically malnourished and 17% are severely stunted.29 Poor availability, affordability and utilization of food have been identified as the primary reasons for malnutrition in the Northern Region. The vast majority of farm holdings in Ghana are subsistence farms and in the Northern Region the smaller the farm holding, the less diverse is the variety of crops cultivated -- usually staple crops. In addition, natural hazards in the Northern Region, such as floods and droughts, disproportionately impact on poor households. Floods have destroyed large areas of cultivated land at crucial times during past cropping seasons, leaving the farming population with reduced harvests to sustain them throughout the year and a damaged asset base that takes a long time to replenish, if at all. With roughly half of the farming households in Northern Region falling below the poverty line, the food price increases of 2008 disproportionately affected these households since only about 30% of households obtain all their food from their own production. In this context, limited household purchasing power is a clear barrier to food access and improved food security. The goal of the RING Project is improved livelihood and nutritional statuses of vulnerable households in targeted communities in the Northern Region of Ghana. The project is funded by USAID/Ghana’s Feed the Future (FTF) and Global Health portfolios. The RING Project is the USAID/Ghana’s principle mechanism for achieving its FTF 27 World Development Indicators, The World Bank. Accessed 04/19/2017 at http://databank.worldbank.org/data/reports.aspx?source=2&country=GHA 28 Cooke, E., Hague, S. and McKay, A. (2016). The Ghana Poverty and Inequality Report: Using the 6th Ghana Living Standards Survey 2016. Accra, Ghana. 29 Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International. (2015). Ghana Demographic and Health Survey 2014. Rockville, Maryland, USA. 38 Intermediate Result 2: Improved Resilience of Vulnerable Communities. The RING Project also contributes to achieving USAID/Ghana’s CDCS Development Objective 3: Equitable Improvements in Health Status. 2. Project Description As defined by USAID, “Resilience is the ability of people, households, communities, countries and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth.” Numerous approaches are commonly used to increase resilience in low-income countries. The goal of RING is to improve livelihood and nutritional status of the most vulnerable households in targeted communities, with an emphasis on women of reproductive age and children under-five (CU5). For the purposes of the project, the most vulnerable communities were selected by analyzing existing district-level data on at least four of the following areas: access to potable water, latrine coverage per household, distances to markets, distances to the nearest health facility, prevalence of infectious diseases in children under five (malaria, acute respiratory infection, and diarrhea). Once those criteria had been assessed for each community, those communities scoring the highest were prioritized for RING inclusion. From there, each community was allocated according to population a number of households that could benefit directly from RING interventions, with the goal of identifying approximately 2,500 households in each of the 17 MMDAs. To undertake selection of households, each district utilized their own staff, community members, or a combination of the two to carry out the field work. To be selected, each household needed to have at least one woman of reproductive age (15-49) and one child under five, and the household had to be classified as ‘vulnerable’ based on the demographics of that particular community. Those undertaking selection of households were trained on how to identify a more vulnerable households using subjective criteria, such as the status of the physical structure of the home (presence of zinc roofing, cement floors, rooms that have fallen down), assets within the family (radio, bicycle, motorcycle, livestock), farming capacity (number of acres under cultivation), and other information such as the presence of additional financial strains (caring for an elderly or chronically ill family member) and the ability of a family to provide 3 square meals a day. Within the particular community, households were assessed against one another and the final proposed list was ultimately validated by community leadership before the households were officially selected for RING direct support30 . Project Objectives The Project Results Framework (see. Annex D) is intended to demonstrate the development hypothesis that strengthening local networks (i.e. district and regional structures) to develop, implement and monitor nutrition, WASH, and livelihoods activities will improve beneficiary nutrition and hygiene behaviors, which, in turn, will improve the nutrition and health status of women of reproductive age and children under five in targeted vulnerable households. The Results Framework contains three Component Results that contribute to the program goal to improve livelihood and nutritional status of vulnerable households in targeted communities in the Northern Region of Ghana. The larger objectives of the program are: 30 In the case of RING, there are multiple interventions that benefit everyone at the ‘community level’, such as borehole repairs, Community Led Total Sanitation, Community Action Planning, and health outreach services, among others. 39 Component 1: Increased access and consumption of diverse quality food among target households, especially among women & CU5; Component 2: Improved behaviors related to nutrition & hygiene for women & children; and Component 3: Strengthened local support networks addressing the ongoing (nutrition & livelihoods) needs of vulnerable households. Through the project interventions, RING expects to contribute to the following results between June 2014 and September 2019: ● 100% increase in income of 80% of target households; ● 20% decrease in prevalence of stunting among children under five; ● 20% decrease in prevalence of anemia among children under five; ● 20% decrease in prevalence of underweight among children under five; and ● 20% decrease in prevalence of wasting among children under five. RING Operational Approach To achieve the goal and component results, and in line with USAID Local Solutions Framework principles of direct support to host governments, RING works with and through the NRCC and 17 MMDAs in Northern Region to select and implement livelihood and nutrition interventions from an evidence-based menu of activities; implementation is funded either through direct awards (i.e. Project Implementation letters or PILs) from USAID or through subcontract from Global Communities. These efforts are carried out via support from several regional partners, including the Regional Planning and Coordination Unit (RPCU) and other allied regional directorates/departments such as the Regional Environmental Health and Sanitation Unit, Regional Agriculture Department, Department of Gender, Department of Community Development, Department of Social Welfare, and the Regional Health Directorate. The RING Project Menu of Activities has been updated numerous times throughout the life of the project based on interventions that are relevant to the partnering MMDAs and GOG priority areas. As of 2017, the menu included the following interventions: Component 1 (Livelihoods): Facilitation of village savings and loans associations (VSLA), cultivation of orange￾fleshed sweet potatoes (OFSP), soybean, and groundnut, and cultivation of leafy green vegetable through drip irrigation systems, shea nut collection and market linkages, soil improvement activities, fowl rearing, post-harvest loss reduction through multiple techniques, and management of small ruminants. Component 2 (Nutrition and WASH): ● Nutrition: Mother-to-mother support groups; community-based nutrition education (durbars, video screenings, cooking demonstrations); training of health workers and community health volunteers; activities to promote community-based management of acute malnutrition; anemia prevention and treatment; essential nutrition actions for non-health staff; quality improvement for health facilities; data utilization and outreach planning support; and ● Water and Sanitation: Community-led total sanitation (CLTS); institutional latrine rehabilitation; repair and maintenance of community borehole and livestock watering areas; development of hand washing facilities in public institutions; rainwater harvesting; building the capacities of water sanitation and management committees (WSMTs); and water quality assessments and treatment. Component 3 (Governance): Facilitation of community scorecard activities; case management of social protection beneficiaries; advancing decentralization at the lower levels; and strengthening of public financial management practices; Gender model family, gender and social protection networks at community and district level, Enhancement of GoG partners M&E capabilities These interventions, when combined, seek to ensure that the most vulnerable households have consistent sources of diverse, high quality food throughout the year and access to related interventions that will improve 40 their livelihoods and nutritional status. Staff members from the 17 MMDAs carry out the activities, while Global Communities provides technical assistance, training, monitoring and support to this cadre. In addition, Global Communities hires consultants to provide intensive support in key areas such as village savings and loans and CLTS. At the conception of the project, USAID/Ghana envisioned directing project funding through government-to￾government agreements to advance Government of Ghana decentralization and USAID Forward principles; as well as strengthen the potential to sustain activities at the end of the project. Although decentralization from national to sub-national structures (i.e. regional, district, sub-district) has been a priority in Ghana for decades, like many countries, decentralization faces many challenges, including weak public financial management at all levels and resource mobilization at the lower levels. After facing several challenges in directing funding from national down to the MMDAs level, USAID/Ghana initially awarded project implementation letters directly to ten districts and the Northern Regional Coordinating Council, each of which had already met the necessary financial and management capacity criteria. The districts met these criteria after undergoing an assessment, which included an analysis of the GoG Functional Organizational Assessment scores, along with an assessment based on USAID’s Public Financial Management (PFM) Risk Assessment Framework. The remaining seven districts were funded through subcontracts through Global Communities, which simultaneously worked to build the districts’ financial management capacity with the intention that they would graduate to direct agreements with USAID. As of today, the number of districts receiving funding from USAID/Ghana through direct agreements increased to 16 of the 17 target districts, with the remaining one district operating under subcontracts to Global Communities. This transition is as a result of those districts making the necessary progress in addressing identified PFM risks, as well as the improving quality of their implementation and management of interventions from a technical standpoint. The RING operational approach entails working with and through the MMDAs and seven departments within the NRCC31, providing capacity building to these partners to strengthen existing GOG systems and subsequent ability to deliver quality services to vulnerable households on a sustainable basis. The GOG partners are responsible for work planning and budgeting, along with service delivery, monitoring, evaluation, and reporting, with technical support on each aspect provided by Global Communities RING. Through RING funding, examples of the GOG services include, but are not limited to: provision of agricultural inputs; training households in good agronomic practices; distribution of small ruminants; formation and support for VSLA; building health worker capacity in nutrition service delivery; social and behavior change communication for improved nutrition, and sanitation and hygiene; potable water access expansion; promotion of subsidy-free sanitation infrastructure; improved PFM; and district sub-structure strengthening, among other things. These interventions, when combined, seek to ensure that the most vulnerable households have consistent sources of diverse, high quality food throughout the year, and access to related interventions that will improve their livelihoods and nutritional status. 3. Strategic Document Sharing To enhance the work of survey team, the following strategy, project, or activity documents will be made available to the team. Other documents not part of the list can also share with the survey team upon a formal request to the Chief of Party of GC RING and Chief of Operation of METSS II and their approval.  Activity Monitoring and Evaluation Plan (AMEP)  Performance monitoring indicators  BBS 2017 data collections tools and report  RING (FY18 annual and FY19Q1 Reports)  Master list of RING Communities Master lists of household and beneficiaries  Draft evaluation questionnaires 31 RPCU, Regional Health Directorate, Regional Agriculture Department, Regional Environmental Health and Sanitation Unit, Regional Department for Community Development, Regional Department of Gender, and Regional Department of Social Welfare. 41  Interventions briefers; and  Other on requested. IV. ILLUSTRATIVE SURVEY QUESTIONS The purpose of this end line beneficiary-based survey (EBBS) is to assess the performance of the GC RING Project. Specifically, the EBBS will estimate the changes in outcomes and outputs of the GC RING 18 survey-based indicators since baseline. In order to guide the process, the following questions will be answered: 8. To what extent has the RING Project achieved its intended goal and objectives as defined by the results framework? a. Has the RING Project’s G2G interventions at the district level resulted in sustainable reduction in hunger and malnutrition for households, especially among children under five? (malnutrition is measured by the nutritional indices of children under-five and hunger is measured by length of months without available food); b. Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD); c. How has GC RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). 9. What unintended outcomes has the RING Project’s Livelihood approach and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level? 10. What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (Effectiveness)? To what extent are the RING interventions likely to continue after USG support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (Sustainability) 11. Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status and hygiene practices? (Efficiency and effectiveness) Apart from providing answers for the above listed questions, the successful survey team will conduct a quantitative survey to provide annual results for the indicators listed in Annex B, as well as provide answers for survey questions in Annex C, which are based on the indicators in Annex B. The successful survey team will be responsible for finalizing the draft data collection tools, sample size and method of collecting data which should be based on the methodology adopted in a previous beneficiary-based survey conducted in 2017. The Survey team will be responsible for implementing the entire survey processes, including collecting quality and quantitative data for responding to the bouquet of questions listed above and in Annex C. V. SURVEY DESIGN AND METHODOLOGY The focus of this EBBS is first, on results of the 18 survey-based indicators of the RING Project and secondly, on the immediate outcomes of the RING Project menu of interventions at the household level within the target districts. It is anticipated that a cross-sectional, before-and-after approach will be adopted for this survey. To enable decision making at the district level, it is expected that statistically representative data should be collected in all the 17 target districts in the RING Zone of Influence. Within each district, adequate sample need to be estimated to ensure that representative data is obtained for each project intervention. The offeror is therefore expected to take the following consideration in its proposal for a sampling methodology and the estimation of a sample size for the survey:  There are four key intervention areas under which activities are implemented by the RING project. Further disaggregated district data analysis will be conducted for project management purposes and is also expected to be statistically significant at the intervention levels within each district. 42  About 94,93332 unique households within the 17 MMDAs have benefited from at least one of the RING supported activities and constitute the universe of households to be surveyed. The effective sample size should be based on this universe.  The list of districts and all communities within that RING ZOI benefiting from key interventions over the life of the project will be provided to the successful survey firm.  To ensure that the baseline and end line results are comparable, the same methodology used at baseline is expected to be used at the end line. The firm is expected to advise and provide inputs on the most appropriate sample and estimation for conducting quantitative data collection to adhere to the following general sampling methodology requirements: o Stratified random sample of MMDA to yield a 95% confidence level at the MMDA, considering population size and heterogeneity; o Sample stratified by sex, age, ethnicity; quota sampling for target groups (e.g. women of reproductive age and Children under five);  The constraining indicators to be used for estimating the sample size for the entire survey, and for the district level sample size estimation are: Prevalence of stunted children under five years of age (HL.9-a); Prevalence of children 6-23 months receiving a minimum acceptable diet (HL.9.1-a); and Prevalence of exclusive breastfeeding of children under six months of age (HL.9.1-b).  The full list of 18 indicators for this survey is attached to this SOW as Annex B. Data required for the indicators and the definitions of all the performance indicators are specified in the performance indicator reference sheets (PIRS), which shall be provided upon request. It is generally anticipated that the firm will employ appropriate scientific data collection and analysis methods to arrive at the survey findings that fully respond to the survey questions and make recommendation thereof. The performance evaluation will cover the RING Project operations since inception, with the key respondents being the project staff, staff of the donor (USAID/Ghana), the project target beneficiaries and staff of RCC, Community members and MMDA staff involved with the implementation of the project. Data collection for the key outcome/output indicators will focus on all project beneficiaries who have received interventions since the inception of the project. The firm is required to share all data collection tools with the RING Project and METSS II Project for review and feedback and or discussion, with sufficient time, before they are applied in the field. They should utilize, to the extent possible various data collection methods including but not limited to the following: VI. Review of Existing Data Documentation: Project documents that should be reviewed may include but not limited to the Project baseline report, the 2017 Beneficiary-Based Survey Report, and relevant annual progress reports, the RING AMEP, and any other assessment reports related to the RING project. VII. Key Informant Interviews: The team is expected to hold interviews with key partners of the project particularly the staff of the MMDAs, and the Regional Directorates involved with implementing the RING Project. Focus groups? Could just do high level interviews VIII. Quantitative data collection tools: as a follow up to the BBS 2017, the firm will be expected to update the BBS 2017 household questionnaire based on the purpose of the survey and with inputs from METSS II and GC RING technical team. IX. DELIVERABLES AND REPORTING REQUIREMENTS Survey Work Plan: The firm (otherwise also called Survey Team) will prepare a detailed work plan and activity schedule to be submitted to the Chief of Operations (COO) of the METSS II and Chief of Party of GC RING for approval no later than five (10) working days after the award. The work plan should describe all activities, including timeframes and sequencing, research design and methodology, sample size estimation and the selection of sampled respondents, draft data collection tools and an analysis plan, and a timeline for 32 New households by year: 2019 (719); 2018 (26,609); 2017 (31,605); 2016 (22,169); 2015 (10,169); and 2014 (3,662). 43 training enumerators and conducting data collection. The METSS II Project’s Research, Monitoring and Evaluation (RM&E) Unit, RING Project’s M&E Unit and USAID/Ghana’s Economic Growth Office’s M&E Specialist and the USAID/Ghana Contracting Officer Representative (COR) for the RING Project will review the submitted work plan and provide written comments no later than five (5) working days after receipt of the detailed work plan. The firm must receive approval of the work plan before beginning the field work. In-briefing: The consulting team is required to organize and conduct an in-briefing with the METSS II Project, USAID/Ghana staff, and key members of the RING project team (e.g., Chief of Party, M&E Specialist, and other Technical Team Leads) for introductions and to discuss the survey team’s understanding of the assignment, initial assumptions, survey questions, methodology, and work plan, and/or to adjust the Statement of Work, if necessary. Mid-term Briefing and Interim Meetings: The consulting team is expected to hold a midterm briefing with METSS II Project, USAID staff and key members of the RING project team on the status of the survey, including potential challenges and emerging opportunities. The team will also provide the METSS II Chief of Operations and RING Project Chief of Party with periodic briefings and feedback on the team’s findings, as agreed upon during the in-briefing. If desired or necessary, weekly briefings by phone can be arranged. End of Data Collection Reporting: The firm is expected to submit a brief report immediately after data collection has ended to provide the status of data collection, stating completion and non-response rates. The data should be disaggregated by District and by the intervention cohorts. Where possible, the firm will present preliminary findings of the survey, which could be frequency distributions of the important variables for each of the 18 target indicators. The firm will share the preliminary findings with Global Communities during an in-person meeting. At which time, Global Communities’ will have the opportunity to discuss the findings and provide comments in oral and written form. The firm will consider the preliminary comments of the key partners and incorporate the comments into the drafting of the survey report. Draft Survey Report: The draft survey report should be consistent with the guidance provided in the reporting requirement sub-section. The report will address each of the questions identified in Annex C of this SOW and any other issues the team considers to have a bearing on the objectives of the survey. Any such issues can be included in the report only after consultation with METSS II and the RING Project. Once the initial draft report is submitted to the METSS II Project COO and the RING COP, the METSS II RM&E team, the USAID staff and the RING project staff will take nine (9) business days to review and submit comments on the initial draft. The firm will integrate the comments into the draft report and submit the final draft report within five (5) business days to METSS II and RING Projects. Each reviewing team (METSS II Project RM&E, RING M&E and USAID) will take five (5) business days to review and submit final comments on the final draft. Final Survey Report: The firm will be asked to take no more than three (3) business days to respond/incorporate the final comments from the contributors (METSS II, RING and USAID). The survey team leader will then submit the final report to the METSS II Project COO and RING COP. All project data and records will be submitted in full and should be in electronic form in an easily readable format, organized and documented for use by those not fully familiar with the project or survey, and owned by USAID/Ghana. The final report will be edited/formatted and presented to USAID and RING Project approximately one month after it has reviewed the content and approved the final revised version of the report. Report Delivery The firm shall submit the final report to METSS II COO and RING COP in electronic format (Microsoft Word) as well as printed and bound copies (Three copies in English) no later than three (3) working days of the receipt of the comments. 44 X. SURVEY TEAM COMPOSITION The contractor must provide information about survey team members, including their curricula vitae, and explain how they meet the requirements in the survey SOW. Submissions of writing samples or links to past survey or evaluation reports and related deliverables composed by proposed team members are highly desirable. Per ADS 201.3.5.14, all team members must provide to USAID a signed statement (i.e., a conflict of interest form) attesting to a lack of conflict of interest or describing an existing conflict of interest relative to the project being evaluated (or surveyed, in this case). Required qualifications and skills:  Experience in survey or evaluation design, methods, management, and implementation;  Technical subject matter expertise in Health and Nutrition, Water, Sanitation and Hygiene, Agriculture, and Governance, particularly knowledge of Ghana’s local assembly system and its implementation mechanisms.;  Background in USAID’s cross-cutting program priorities, such as gender equality and women’s empowerment, youth, etc.;  Experience working in Northern Ghana; and  Ability to communicate in the local languages of the Zone of Influence (ZOI) would be an added advantage. Proposed key personnel are expected to be the people who execute the work of this contract. Any substitutes to the proposed key personnel must be vetted and approved before they begin work. The Project may request an interview with any of the proposed evaluation team members via conference call, Skype, or other means. The survey team will consist of a team leader and three technical experts. A representative from METSS II Project, RING and USAID may be asked to join the survey and participate in the survey processes. It is anticipated that the firm should have the following experience: Team Leader/Expert in Health and Nutrition or Agricultural Economics/Applicable Social Science: Qualification and Experience  Specialist should have a postgraduate degree in health, nutrition or agricultural economics, or an applicable social science field. S/he should have at least 10 years’ senior level experience working in the agricultural, nutrition, WASH and Governance sectors in a developing country context.  S/he should have extensive experience in project management, conducting both qualitative and quantitative evaluations/ assessments and strong familiarity with the health and nutrition, WASH or agriculture sector in Ghana.  Excellent oral and written skills in English are required.  The Team Leader should also have experience in leading survey teams and preparing high quality documents. The Team Leader will take specific responsibility for estimating the results of the 18 target indicators and for assessing and analyzing the project’s progress towards achieving its goal and objectives, factors for such performance and benefits/impact of the interventions implemented by the project.  Good interpersonal and diplomatic skills.  S/he will should have experience in providing leaderships for team in finalizing survey design, coordinating activities, arranging periodic meetings, consolidating individual input from team members, and coordinating the process of assembling the final findings and recommendations into a high quality document.  S/he will write the final survey report.  S/he will also lead the preparation and presentation of the key survey findings and recommendations to METSS II Project, RING Project and USAID. Senior Survey Specialist: Qualification and Experience 4. Master's Degree or equivalent in a health and nutrition or an agricultural field (Agricultural economics, agribusiness, agricultural extension and rural sociology, or any other relevant health field), social sciences or related relevant fields. 45 5. Must have a minimum of 8 years conducting both qualitative and quantitative surveys/evaluations around health and nutrition, WASH, agriculture productivity, value chain enhancement, improving capacity for service delivery and decentralized governance in developing countries. 6. Good interpersonal and diplomatic skills. 7. Excellent oral and written communication skills in English. Two Other Team Members: Qualifications and Experience  A proven record of leadership in research, sound technical knowledge and relevant experience in the health and nutrition, WASH, agricultural and local governance sectors, social sciences or related relevant fields are required. Experience in program design and implementation, analysis and report writing are an advantage;  Experience in conducting both qualitative and quantitative surveys/evaluations around health and nutrition, WASH and agriculture; and  Excellent spoken and written skills in English. In addition to the above listed key personnel, within the first few weeks of implementation, the survey team will also be required to recruit and train enumerators to assist with collecting data from the sampled households. METSS II will share a set of criteria for selecting enumerators with the Firm to provide a level of quality assurance to the process and ensure all enumerators hired are in compliance with GOG and USG guidelines. At a minimum, enumerators should possess at least a Bachelors’ degree in a field related to health, nutrition, agriculture or related social science field. The enumerators should also have experience collecting data in rural areas in Ghana, particularly, in Northern Ghana. Enumerators who have undertaken surveys planned and implemented with USG resources, or managed by the GSS would be an advantage. All team members will be required to provide a signed statement attesting to a lack of conflict of interest or describing any existing conflict of interest. XI. SURVEY SCHEDULE Survey Period of Performance Work is to be carried out over a period of approximately 12 weeks, beginning o/a April 15, 2019 with field work and draft report completed by July 1, 2019 and final report and close out concluding July 18, 2019. Illustrative Schedule Timing (Anticipated submission date) Anticipated Duration (Days)33 Proposed Activities 15th April 2019 Survey contract awarded to firm 22nd April 2019 5 Firm prepares and submits a detailed survey work plan to METSS II and RING Projects 26th April 2019 3 Survey team (firm) conducts in-brief with METSS II Project, RING Project and USAID/Ghana on survey work plan 6 th May 2019 4 METSS II, RING and USAID/Ghana review survey work plan and submit feedback to survey team 9 th May 2019 3 Survey team integrates comments into work plan and submits final document to METSS II and RING Projects 16th May 2019 5 Survey team completes pre-testing of survey questionnaire/instruments/tools 23rd May 2019 5 Survey team trains survey enumerators and supervisors 33 This is only for weekdays 46 Timing (Anticipated submission date) Anticipated Duration (Days)33 Proposed Activities 10th June 2019 12 Collect data from survey respondents in the project target areas 21st June 2019 9 Data Analysis 24th June 2019 Half day Survey validation meeting for presentation of preliminary findings 1 st July 2019 5 Write draft report and submit preliminary findings 8 th July 2019 5 METSS II, RING and USAID/Ghana review survey draft report and submit feedback to survey team 15th July 2019 5 Survey team incorporates comments and prepare final survey report 18th July 2019 3 Survey Team Leader submits formatted Final Survey Report Est. Total # of Days 64.5 Payment Schedule Payment under the prospective survey contract shall be as follows:  45% upon submission of Survey Work Plan to METSS II Chief of Operations.  30% upon submission of Draft Survey Report to METSS II Chief of Operations.  25% upon submission of Final Survey Report to METSS II Chief of Operations. Schedule for preparing the work plans and survey design The firm should plan to receive all key documents, and prepare a detailed work plan for the survey and submit to the METSS II Project COO and RING COP for review prior to the commencement of field work. It is expected, within the period of preparing the detailed work plan that the team members will begin to make key contacts and plan the recruitment of enumerators for the data collection phase of the assignment. Key contacts should also be obtained for interviews and discussions with project staff, and other key stakeholders. Most of this work should be done through meetings and site visits. The team will work through the METSS II COO and the RING COP or their designees to support setting up of as many meetings and interviews as possible. Schedule for collecting data The survey has qualitative elements, which will complement the quantitative data to enable the survey team to measure progress towards meeting the project goal and objectives. The focus at the beginning of the data collection period should be on meeting with USAID, RING Project and METSS II Project staff, and gathering and reviewing data not already available. The survey team should also solidify plans for meetings and visits to beneficiaries and stakeholders to gather qualitative data. The team should strategically finalize their recruitment and plans for training data collectors, which should take place immediately after finalizing the detailed work plan and survey questionnaires. Data collection for the outcome indicators will be done using tablets (these should not be included in the budget; they will be provided by METSS II or the GC RING team). The electronic data capture tool, simulating the data collection tools for the quantitative element of the survey should also be developed during this period. The training of enumerators will be based on both the paper questionnaire and electronic version of the questionnaire. It is expected that the survey team will randomly sample beneficiaries to collect adequate data for the survey report. As time allows, the team will begin analyzing data and preparing the first few sections of the final report during this period. 47 Data Analysis The survey team are expected to immediately start data analysis using appropriate methods as indicated in the detailed survey work plan. The analysis will serve as basis for the completion of the survey reports. XII. FINAL REPORT FORMAT The survey final report should include an executive summary; introduction; background of the project context; the survey purpose and questions; the methodology; the limitations to the survey; key findings, conclusions, and recommendations; and lessons learned (if applicable). The survey report should be easily understood and should identify key points clearly, distinctly, and succinctly. The findings should be presented as analyzed facts, evidence, and data and not based on anecdotes, hearsay, or simply the compilation of people’s opinions. The Executive Summary should be 2-5 pages in length and present a concise and accurate statement of the most critical elements of the report. It should summarize key points (purpose and background, survey questions, methods, findings, and conclusions). The report should provide a brief Background information, which should include country and/or sector context; specific problem or opportunity the intervention addresses; and the development hypothesis, theory of change, or simply how the intervention addresses the problem. Describe the specific strategy, project, activity, or intervention implemented including (if available) award numbers, award dates, funding levels, and implementing partners The Survey Purpose and Questions should state the purpose of, audience for, and anticipated use(s) of the survey. Clearly state the survey questions in this section. Explain the survey Methodology in detail and clearly state sources of information. Disclose limitations to the survey, especially, those associated with the methodology (e.g. selection bias, recall bias, unobservable differences between comparator groups, etc.). NOTE: A summary of methodology can be included in the body of the report, with the full description provided as an annex. Findings, Conclusions, and Recommendations: Address all survey questions in this Statement of Work (SOW) or document why some survey questions and/or comments from METSS II Project or the RING Project have not been addressed for approval. If survey findings assess person-level outcomes, they should also be separately assessed for both males and females. Findings and conclusions should be specific, concise, and supported by strong quantitative or qualitative evidence. If recommendations are included, separate them from findings and conclusions. Recommendations should be supported with specific findings and should be action-oriented, practical and specific. The Annexes to the report shall include:  The Survey SOW;  Any statements of difference regarding significant unresolved differences of opinion by USAID/Ghana, METSS II Project, RING Project, and/or members of the consulting team;  Indicator data result tables with accompanying statistics (such as the indicator result, the sample size, the confidence interval, standard error and significant tests, where applicable)  All data collection and analysis tools used in conducting the survey and/or survey, such as questionnaires, checklists, and discussion guides;  All sources of information, properly identified and listed;  Signed disclosure of conflict of interest forms for all survey team members, either attesting to a lack of conflict of interest or describing existing conflicts of interest; and 48  Summary information about survey team members, including qualifications, experience, and role on the team. The final version of the survey report will be submitted to METSS II Project and RING Project in hard copy as well as electronically. The report format should be restricted to Microsoft products and 12- point font type should be used throughout the body of the report, with page margins 1” top/bottom and left/right. The report should not exceed 35 pages, excluding references and annexes. The survey team leader shall incorporate METSS II Project, RING Project, and USAID’s comments and submit the final report to METSS II Project and RING Project in electronic format (Microsoft Word) as well as printed and bound copies (Three copies in English) no later than three working days of the receipt of the comments. XIII. CRITERIA TO ENSURE THE QUALITY OF THE SURVEY REPORT Per this SOW, an independent report shall be prepared for the survey in accordance with USAID evaluation reporting guidelines. The draft and final survey reports will be evaluated against the following criteria to ensure the quality meets the minimum standards of a USAID-sponsored survey:  The survey reports should represent a thoughtful, well-researched, and well-organized effort to objectively evaluate the project.  The report should be easily understood and should identify key points clearly, distinctly, and succinctly.  The executive summary of the report should present a concise and accurate statement of the most critical elements of the report.  The report should adequately address all survey questions included in the statement of work, or the survey questions subsequently revised and documented in consultation and agreement with METSS II Project, RING Project, and USAID.  The methodology should be explained in detail and all sources of information properly identified in the report.  Limitations to the survey should be adequately disclosed in the report, with particular attention to the limitations associated with the methodology (selection bias, recall bias, unobservable differences between comparator groups, etc.).  Findings should be presented as analyzed facts, evidence, and data and not based on anecdotes, hearsay, or simply the compilation of people’s opinions.  Findings and conclusions should be specific, concise, and supported by strong quantitative or qualitative evidence.  If findings assess person-level outcomes, they should also be separately assessed for both males and females.  Recommendations should be supported by a specific set of findings and should be action-oriented, practical and specific. XIV. SURVEY MANAGEMENT Logistical Support The RING Project will support with necessary logistical arrangements. RING will collaborate with the METSS II project to help the survey team identify key documents, and arrange for meetings with stakeholders. The survey team is responsible for arranging other meetings as identified during the course of the survey and may request support from GC RING and METSS II. In all these arrangements the USAID/Ghana RING COR and EG Office M&E Specialist should be notified prior to each of these meetings. Upon request from the contractor with reasonable notice, the RING Project will arrange for vehicles needed for site visits, and meetings, and will assist with hotel arrangements, if necessary. However, the survey team members will be required to make their own payments for lodging, meals and incidental expenses. RING will make available their conference room or another convenient location upon request of the survey team as workspace. However, the survey team are expected to use their own computers. 49 Technical Direction Technical direction during the performance of the survey will be provided by the METSS II Chief of Operations, who will be the point of contact for the firm’s team during performance. The METSS II Chief of Operations will manage the technical execution of survey in consultation with the USAID/Ghana RING COR and EG Office M&E Specialist. In the event that the firm believes that it is required to perform activities outside the survey SOW, it must immediately contact/inform the METSS II Chief of Operations before performing these tasks. The RING COP will manage the administrative aspect of the survey including recruiting and signing contract with the Survey team. The RING Chief of Party is the only authorized official to make changes to the administrative terms and conditions of the survey contract. In the event that the firm believes that it is required to perform activities outside the survey contract, it must immediately contact/inform the RING COP and METSS II COO before performing these tasks. The firm will not be paid any amount in excess of the survey budget set forth in the survey contract. RFP No. GC/RING/FY19/001 Page 50 ANNEX A: Evidence of Responsibility 1. Eligibility to Receive Award Company Name certifies that it is qualified and eligible to receive an award for the provision of describe goods or services under applicable laws and regulations of the United States and Name of Host Country. 2. Authorized Negotiators Company Name proposal for Project Name may be discussed with any of the following individuals. These individuals are authorized to represent Company Name in negotiation of this offer in response to this RFQ. List Names of Authorized signatories Address Telephone/Fax Email address 3. Adequate Financial Resources Company Name has adequate financial resources to implement this Contract. 4. Ability to Comply Company Name is able to comply with proposed contract terms and delivery schedule having taken into consideration all existing business commitments, commercial as well as governmental. 5. Record of Performance, Integrity and Business Ethics Company Name certifies that Company Name and/or any of its Principals are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any donor agency; and have not, within a three-year period preceding this proposal, been convicted of or had a judgment rendered against them for commission of fraud or a criminal offense; and have not, within a three-year period preceding this proposal, had one or more contracts terminated for default by any donor agency. 6. Certification Regarding Terrorism Financing Company Name certifies that it is not on the U.S. Department of Treasury Office of Foreign Assets Control (OFAC) Specially Designated Nationals (SDN) List and is eligible to participate in this solicitation. 7. Organization, Experience, Accounting and Operational Controls, and Technical Skills Company Name has the necessary organization, experience, accounting and operational controls, and technical skills, or the ability to obtain them. 8. Equipment and Facilities Company Name has the necessary production, construction, and technical equipment and facilities, or the ability to obtain them. By signature hereon, the Bidder certifies that these statements are accurate, current, and complete. Date: Name: Signature: ___________________________ 51 ANNEX B: List of RING Project Indicators for 2019 End Line Beneficiary-based Survey No. Results Area Indicator Title Level of Disaggregation 1 Improved livelihood and nutritional status of vulnerable households in targeted communities in the Northern Region of Ghana HL.9-a: Prevalence of stunted children under five years of age (R ) Male Female 2 Improved livelihood and nutritional status of vulnerable households in targeted communities in the Northern Region of Ghana HL.9-c: Prevalence of underweight children under five years of age(R) Male Female 3 Improved livelihood and nutritional status of vulnerable households in targeted communities in the Northern Region of Ghana HL.9-b: Prevalence of wasted children under five years of age(R Male Female 4 Increased diversification of income throughout the year among target households RING 1.1.2.1: Percent (%) of households who state they are more financially secure Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA) 5 Increased availability of affordable, diverse plant and animal foods throughout the year among target households RING 1.1.3.1: Percent (% ) of target households benefiting from crop intervention reporting use of techniques to reduce post-harvest losses Location: District 6 Increased availability of affordable, diverse plant and animal foods throughout the year among target households RING 1.1.3.2: Percent (% ) of target households reporting shorter lean season Location: District Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA). 7 Increased availability of affordable, diverse plant and animal foods throughout the year among target households RING 1.1.3.6: Percent (%) of targeted households who have increased their income through RING supported activities 8 Improved behaviors related to nutrition and hygiene for women and children RING 1.2.1: Percent (%) of households adopting improved nutrition practices Location: District Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA) 9 Increased adoption of positive nutrition behaviors among target households RING 1.2.1.1: Percent (%) of respondents in target communities knowledgeable of appropriate infant and young child feeding practices Location: District Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA) 52 No. Results Area Indicator Title Level of Disaggregation 10 Increased adoption of positive nutrition behaviors among target households RING 1.2.1.2: Number of service delivery channels that mainstream appropriate nutrition messages throughout the community 11 Increased adoption of positive nutrition behaviors among target households HL.9.1-c: Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age 12 Increased adoption of positive nutrition behaviors among target households HL.9.1-a: Prevalence of children 6- 23 months receiving a minimum acceptable diet Sex: Male, Female 13 Increased adoption of positive nutrition behaviors among target households HL.9.1-b: Prevalence of exclusive breastfeeding of children under six months of age Sex: Male, Female 14 Increased adoption of hygiene and sanitation behaviors in target households and their communities HL.8.2-5: Percentage of households with soap and water at a handwashing station commonly used by family members 15 Increased adoption of hygiene and sanitation behaviors in target households and their communities HL.8.2-6: Percentage of households in target areas practicing correct use of recommended household water treatment technologies 16 Increased adoption of hygiene and sanitation behaviors in target households and their communities RING 3.1.8.1-2: Percent (%) of respondents who know any 3 critical times of hand washing Location: District Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA) 17 Strengthened local support networks addressing the ongoing (nutrition and livelihoods) needs of vulnerable households RING 1.3.1: Percent (%) of households reporting improvements in nutrition and livelihood services from local government Type of service: Nutrition, Livelihood, and WASH Location: District 18 Strengthened capacity of target DAs and the NRCC to respond to community priorities for improved nutrition and livelihoods RING 1.3.1.8: Percentage of core RING implementing departments that use community feedback to inform planning processes for their RING Annual Work Plans and Budgets and/or District Annual Action Plans ANNEX C: Suggested Additional Research Questions for the RING Project 2019 End Line Beneficiary-based Survey Agriculture & Livelihoods Components  Since participating in RING, have you undertaken any new income generating activities to diversify your income sources? If so, what are they? Or… o How many sources of income do you have now versus five years ago?  Do you feel that the nutritional status of your family has improved, as compared to when you began participating in RING interventions?  Do you feel that the economic status of your family has improved, as compared to when you began participating in RING interventions? 53  Compared to last year, how do you compare your current food access situation - do you feel comfortable with the amount of food you have in storage from last year’s harvest? Do you have additional income to purchase surplus foods? Do you have more bartering power to leverage for additional food, if needed? o (tied to Indicator #17 and % of households reporting a shorter lean season) o Perhaps optional – shorter, longer, the same  Have your income levels improved since being engaged in RING programming?  Suggestion on altering the question: In the past year, how much did you receive from selling your surpluses, including grains and animals? – can we leave it open ended instead of providing ranges to enable us to get a better average figure? For households receiving direct input support34 in 2014-2016:  Were you able to maintain your intervention after direct input support from the Assembly halted (i.e. continued farming soybean or groundnut without seed and tractor service provision, expanded their small ruminant herd)? o If so, what were some of the greatest challenges? o If not, what were some of the challenges you were unable to overcome? For households receiving direct input support35 in 2017-2018:  Moving forward, what are some of your greatest concerns over the management or continuation of the intervention you received from the Assembly, now that direct input support will no longer be provided? o What are your plans to address those concerns, if any? Sustainable Agriculture Practices:  Poultry and/or small ruminant beneficiaries: do you practice sustainable agricultural practices by applying poultry manure on their farms? o If so, have you observed any benefits? Please describe. o If not, can you describe some of the challenges that prevent you from doing this?  Were you trained on intercropping and other conservation farming methodology? o If so, do you still practice those approaches? o If no, why not? For soybean and/or groundnut beneficiaries that utilize PICS bags:  Did you utilize the PICS bag technology after harvesting groundnut or soybeans? If so, did it make a positive impact on quality of the grains in storage? Did you feel it helped your harvest last for longer into the dry season? Nutrition Component  (follow up on question – for which of the following public services have you seen an improvement in in the last year?) If you have not seen an improvement, what are some of the challenges? What are some suggestions for further improvement? If it has improved, in which areas?  In the past 12 months, have you had any health services provided to you by a CHPS/Health Center staff at the facility or at home? o If yes, what were they? o Were you satisfied with the care you received?  How could it have improved?  Have you received any nutrition or health-related counseling from a non-health worker (i.e. environmental health agent, AEA, Community Development or VSLA officer) in the last six months? o If so, what advice did you receive? 34 Interventions would include: soybeans, groundnuts, small ruminants, poultry, leafy green vegetable cultivation, OFSP cultivation, and VSLA. 35 Interventions would include: soybeans, groundnuts, small ruminants, poultry, leafy green vegetable cultivation, OFSP cultivation, and VSLA. 54 WASH Component  (follow up question to the hand washing at critical periods knowledge versus practice) If you are aware of critical times to wash your hands with soap and water, but do not adhere to this practice, what are some of the challenges you face in doing so?  (follow-up to the main water source question – for those using ‘unimproved sources of water’) Why do you use this water source? o Note: tied to availability of potable water/improved water sources in the community – perhaps only unimproved sources are available, perhaps the taste of dam water is preferred to that of the borehole, etc.  (follow up question to whether someone is satisfied with their current water sources) If not satisfied, why are you not satisfied? (if water source is unimproved, but the person is satisfied) Why are you satisfied with this source of drinking water?  (follow up as to whether the household has an improved latrine – if yes) Did you utilize any income generated or earned from RING interventions to support the installation of this latrine? For instance, a VSLA loan, selling a small ruminant, sales of soybean or groundnut or OFSP harvests, etc. List those sources. Governance Component  (follow up to question: Have you participated in a community engagement forum with the District Assembly?) If yes, did the Assembly discuss their budgeting and planning process for development projects for the year?  (follow up to question: Have you spoken to your Assembly Person or Unit Committee Member about a community development issue?) If yes, what issue what it about? Did they respond appropriately to your concern? Were you satisfied with that response? Why, or why not?  Are you satisfied with the level of technical support you have received from your local government officials within the interventions you have received? OR… o How would you rate your satisfaction level with extension support services you have received from your local government officials (use a Leichardt Scale) o This variation may require multiple entries if satisfaction varies by sector, i.e. very high with health, but poor with agriculture.  Have you recently paid any levees or tax rates to the Assembly and if so, are you aware of what those rates are for/will contribute to?  In the last 12 months, has your family been supported by the Assembly to renew or register for the National Health Insurance Scheme? o If so, how many people benefitted? (get ages, or ranges, if possible)  (follow-up question to Are you a LEAP Beneficiary?) If yes, how many people in your household are registered as a beneficiary? Other areas to consider (GOG-focused questions) General:  Regarding the core interventions in your respective area, do you feel your overall technical capacity to implement those interventions and provide the necessary community and/or household follow-up support has improved in the last five years? o If so, how? o If not, what are some reasons why?  Were you involved in or aware of the process in targeting the RING communities and households that eventually benefitted from the project? o If so, were you satisfied with the selection process? 55 o Do you have any recommendations to improve on this process?  Which interventions within your technical sector (or in general) do you believe have the highest potential for sustainability and why?  Which activities do you believe are highly effective under RING, but may face challenges in being sustained by the Assembly? o What are some of those challenges?  Which (choose: agriculture, livelihoods, nutrition, WASH, good governance [including gender & social protection]) intervention did you personally feel was most effective and why? Which ones were the least effective and why? o Any different interventions for that sector you would have suggested? What is your rationale (when tying it back to a malnutrition and poverty reduction program)? o Note: we do not necessarily need to limit the ‘agric officers’ to providing feedback only on agric interventions; because of the integrated nature of the project, health may have good advice on environmental health, while ag can speak to nutrition efforts as well.  Do you believe that community engagement mechanisms across all sectors (i.e. integrated durbars, Citizen’s Forums, cooking demonstrations, video screenings, MTMSG, etc.) are an effective means of disseminating information to the public? Why or why not? o What are some ways this can be improved?  Which are some interventions that you personally believe the Assembly as a whole did not capitalize on during the life of RING that could have made a lasting impact on the effectiveness of the Assembly’s general operations or fulfillment of its core mandates OR on the direct benefits to the households participating in certain interventions? o Note: trying to get at some missed opportunities here  How would you characterize your district’s inter-departmental coordination and collaboration under RING? (use a Leichardt Scale) o If strong, do you believe this collaboration will continue after RING? Why or why not? Governance:  In addressing identified PFM risks, can you provide some specific examples of how implementation of the risk mitigation plans may have improved internal controls or general MMDA operations, if at all? o What is your personal outlook on the sustainability of the PFM efforts? o If you foresee any challenges, what might some of those be? And what suggestions do you have to mitigate those issues?  In your opinion, have Governance interventions, such as Citizen’s Forums, Town Hall Meetings, PFM, community action planning, and social protection, among others, contributed to achieving improved nutrition and resiliency outcomes? o If yes, please explain your rationale. o If no, what are some of the challenges?  How would you rate the overall functionality of your district’s sub-structures? (use a Leichardt Scale) o What is the correlation, if any, between sub-structure functionality and the Assembly’s ability to fulfill some of its core mandates?  Has the overall functionality of the Area Councils improved the internally generated funds mobilization? o And if yes, by what margin? o If no, what are some of the challenges?  What areas do you typically expend the Internally Generated Funds on?  What are some recommendations you have on improving the management of Internally Generated Funds? (emphasize that the answers are anonymous) M&E  When planning for interventions, during actual implementation, and during monitoring and evaluation, how often did you as an individual (or department) utilize data for decision making, as compared to before RING partnered with your district?  Has your district fully launched the NORMIS efforts? o If so, what has been the impact, if any, on service delivery, project planning, and timely and harmonized reporting? 56 o What are some of the challenges you have faced, if any, in the use of the NORMIS? o Note: this may need to be focused on certain officers within the Assembly  Have you benefitted from any of the M&E e-learning modules? To what extent, if any, have they supported improving your internal M&E capacity? o Note: this may need to be focused on certain officers within the Assembly  To what extent has the establishment of resource centers eased your work in data management and storage? o Note: this may need to be focused on certain officers within the Assembly Agriculture  How would you characterize your experience in receiving direct funding via the Assembly through RING? (use a Leichardt Scale) Please explain any challenges or benefits. Health/Nutrition:  Can you provide some specific examples in how RING has contributed to improving the nutrition services delivery, if at all?  Has RING effectively contributed in engaging the entire family to improve nutrition? o If so, how? o If not, what do you believe are some of the challenges? Current Facility-Level Skills & Assets:  Does this facility have at least one staff that has been trained in: o Anemia prevention & control protocols o CMAM o IYCF Counseling o Commodity Management o QI  Do facilities have access to essential equipment, such as: o Counseling cards o Weighing scales (functional) o Height board o HemoCue devices (functional) o Microcuvettes (sufficient supply for one quarter) Other  Can we also work on a methodology to capture intended and unintended outcomes? Possibly by thematic area, or at the Assembly (systems strengthening efforts)? It may be too challenging to undertake at the household level.  Can we look at the stunting, wasting, anemia, and underweight status for the RING beneficiary households specifically? The DHS is nationwide with smaller regional sample sizes and would not necessarily provide the most accurate project-specific information. RFP No. GC/RING/FY19/001 Page 57 ANNEX D: RING Project Results Framework RING Development Hypothesis: If local networks (i.e. MMDAs, NRCC and Community-based Organizations and [CBO] and NGOs) are strengthened to develop, implement and monitor nutrition & income growth activities, THEN the nutrition and livelihood status among targeted vulnerable households will improve. 58 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX E: Feed the Future Results Framework 59 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX II: SUMMARY OF PROJECT BENEFICIARIES BY DISTRICT AND ALLOCATION OF SAMPLE SIZE District Total # of beneficiaries Proportion of total beneficiaries Proportion of sampled beneficiaries # of communities’ beneficiaries were sampled from Central Gonja 6456 0.063353123 131 7 Chereponi* 0 East Gonja 7963 0.078141406 161 9 East Mamprusi 5811 0.057023699 118 7 Gushegu 8041 0.078906825 163 9 Karaga 6022 0.059094254 122 7 Kpandai 7267 0.071311516 147 8 Kumbungu 7066 0.06933909 143 8 Nanumba North 7251 0.071154507 147 8 Nanumba South 6194 0.060782101 125 7 North Gonja 6614 0.064903587 134 7 Saboba 8169 0.080162897 165 9 Sagnarigu 4926 0.048339139 100 6 Savelugu-Nanton 5443 0.053412492 110 6 Tamale Metro 5479 0.053765762 111 6 Tolon 5154 0.050576517 104 6 West Gonja 4049 0.039733085 82 5 Grand Total 101905 1 2063 115 *Eliminated because there is currently a security challenge in the district ANNEX III: SOURCES OF INFORMATION  FTF Ghana Population-based Survey in Northern Ghana: Baseline Protocol  RING and SPRING baseline questionnaire  2017 BBS questionnaire  Nutrition and poverty in Northern Ghana questionnaire  2014 Ghana Demographic and Health Survey questionnaire  Feed the Future ZOI Survey Methods - Questionnaire – 20181201  Feed the Future Indicator Handbook – March 2018 60 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX IV: DATA COLLECTION INSTRUMENTS Final Household Questionnaire_17-06-19.docx Revised qualitative tools_10.06.19.docx 61 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX V: SOURCES OF DATA BASED ON EVALUATION THEMES AND KEY EBBS QUESTIONS Main question Sub question Source of data Data collection instruments To what extent has the RING Project achieved its intended goal and objectives as defined by the results framework? Has the RING Project’s G2G interventions at the district level resulted in sustainable reduction in hunger and malnutrition for households, especially among children under five?  Primary data (interview of beneficiaries)  SPRING&RING Baseline report  2017 BBS report HH questionnaire Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD);  Primary data interview of beneficiaries  SPRING&RING Baseline report  2017 BBS report HH questionnaire How has GC RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities? (For target MMDAs, and communities). Primary data (KII with Dist Assembly staff and staff of decentralized departments) KII Guide What unintended outcomes has the RING Project’s Livelihood approach and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level? Primary data (interview with beneficiaries) Primary data (interview with RING staff, Staff of decentralized depts) HH questionnaire FGD Guide KII guide Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status and hygiene practices? (Efficiency and effectiveness) Primary data interview of beneficiaries SPRING&RING Baseline report 2017 BBS report HH questionnaire What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (Effectiveness)? Primary data in (interview with NRCC, Dist Assemblies, RING project staff and management and partners) FGD Guide – beneficiaries KII stakeholders 62 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Main question Sub question Source of data Data collection instruments To what extent are the RING interventions likely to continue after USG support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (Sustainability) Primary data in (interview with NRCC, Dist Assemblies, RING project staff and management and partners) FGD Guide – beneficiaries KII stakeholders ANNEX VI: INDICATORS AND MEASUREMENT APPROACHES FOR KEY STUDY QUESTIONS Question Indicators Measurement approach To what extent has the RING Project achieved its intended goal and objectives as defined by the results framework? The answers to this question were provided by analyzing the issues that addressed questions a, b and c below: a. Has the RING Project’s G2G interventions at the district level resulted in sustainable reduction in hunger and malnutrition for households, especially among children under five?  Prevalence of stunted children under five years of age  Prevalence of underweight children under five years of age  Prevalence of wasted children under five years of age  Percent (%) of target households reporting shorter lean season  The before-and-after research approach was adopted to measure the effects of the project on stunting, wasting and underweight. The end line evaluation data was compared with existing data (including baseline and mid-line data and annual beneficiary-based survey) to identify changes that occurred due to the project interventions. Qualitative data was also collected and analyzed so as to provide a deeper understanding and contextual information to the observed changes. b. Have the combined efforts in WASH, Nutrition and Livelihood activities resulted in improved nutrition and hygiene behaviors for households in the target districts? (Indicators of interest here are MAD, WDD);  Percent (%) of households adopting improved nutrition practices  Percent (%) of respondents in target communities knowledgeable of appropriate infant and young child feeding practices  Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age  Prevalence of children 6-23 months receiving a minimum acceptable diet  Prevalence of exclusive breastfeeding of children under six months of age  Percentage of households with soap and water at a handwashing station commonly used by family members EBBS data was compared with existing data (including baseline and 2017 BBS) to identify changes that have occurred due to the project interventions. Qualitative data was also collected and analyzed so as to provide understanding and explanation to the observed changes. 63 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Question Indicators Measurement approach  Percentage of households in target areas practicing correct use of recommended household water treatment technologies  Percent (%) of respondents who know any 3 critical times of hand washing c. How has GC RING activities strengthened local support networks to address the nutrition and livelihood needs of vulnerable communities?  Percent (%) of households reporting improvements in nutrition and livelihood services from local government  Number of service delivery channels that mainstream appropriate nutrition messages throughout the community  Percentage of core RING implementing departments that use community feedback to inform planning processes for their RING Annual Work Plans and Budgets and/or District Annual Action Plans  The EBBS data was compared with existing data (including baseline and 2017 BBS) to identify any changes that may have occurred due to the project interventions. Qualitative data was also collected and analyzed to determine if local support networks were strengthened by the project What unintended outcomes has the RING Project’s Livelihood approach and activities achieved relative to improving farmer incomes and reducing vulnerability at the household level?  Percent (%) of households who state they are more financially secure  Percent (%) of target households benefiting from crop intervention reporting use of techniques to reduce post-harvest losses  Percent (%) of targeted households who have increased their income through RING supported activities EBBS results related to HH income and vulnerability were compared to that of 2017BBS and baseline. Analysis of qualitative data was done to identify reported outcomes which were not part of project results indicators. Analysis of quantitative data was done to identify outcomes that were not part of project results, through generating data for indicators that were not part of the core project indicators. Which RING interventions are the most effective and least effective at improving livelihoods, nutritional status and hygiene practices? (Efficiency and effectiveness) Effectiveness was considered at two levels, namely project management level and project beneficiary level. It was looked at in terms of whether the project was implemented the way it was intended, and if yes, how, and if not, why not? Were there some interventions that were not implemented, why? Analysis of the results related to each intervention was done to determine which intervention produced the most results. Qualitative data was collected and analyzed to determine the factors that affected project efficiency. 64 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Question Indicators Measurement approach What can be identified as lessons learned and best practices and from which stakeholders or beneficiaries? (Effectiveness)? To what extent are the RING interventions likely to continue after USG support? Is stakeholder buy-in likely to continue or be increased after the current project expires? (Sustainability)  % of project beneficiaries who indicate they can continue project activities  Key actors’ ability and willingness to continue project interventions  Lessons learnt in project implementation  Key factors of sustainability Quantitative data on beneficiaries’ willingness and ability to continue livelihood activities supported by project The Likert-scale type of questions was used to assess the beneficiaries’ perception about project continuity). Qualitative data on lessons learnt and sustainability factors. 65 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX VII: DISCLOSURE OF ANY CONFLICTS OF INTEREST 66 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project 67 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project 68 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project 69 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX VIII: RESULTS OF CORE 18 INDICATORS BY DISTRICT AND TYPE OF HOUSEHOLD Table 9: HL.9-a: Prevalence of stunted children under five years of age by sex, age group and district Group Weighted N Unweighted N -3SD (95% CI) -Severe -2SD (95% CI)- Moderate z-score mean (95% CI) z-score SD All 2043.0 2117 6.6 (5.5; 8.0) 21.9 (19.8; 24.0) -0.9 (-1.0; -0.8) 1.58 Age group: 00-05 mo 203.6 215 2.7 (1.1; 6.3) 7.5 (4.2; 13.1) 0.6 ( 0.3; 0.8) 1.65 Age group: 06-11 mo 191.6 201 2.4 (0.9; 6.6) 6.5 ( 3.6; 11.4) -0.1 (-0.3; 0.1) 1.47 Age group: 12-23 mo 493.3 512 5.0 (3.3; 7.5) 19.5 (15.8; 23.9) -0.9 (-1.0; -0.7) 1.40 Age group: 24-35 mo 463.6 478 7.3 (5.0; 10.7) 23.3 (19.2; 28.0) -1.1 (-1.3; -0.9) 1.56 Age group: 36-47 mo 406.2 420 9.6 (6.7; 13.5) 30.3 (25.3; 35.8) -1.5 (-1.6; -1.3) 1.29 Age group: 48-59 mo 284.7 291 9.9 (6.5; 14.7) 32.0 (25.9; 38.9) -1.3 (-1.5; -1.1) 1.47 Sex: Female 991.1 1027 5.4 (4.0; 7.2) 20.0 (17.3; 23.1) -0.7 (-0.9; -0.6) 1.59 Sex: Male 1051.9 1090 7.8 (6.2; 10.0) 23.6 (20.7; 26.7) -1.0 (-1.1; -0.9) 1.56 Age + sex: 00-05 mo.Female 106.7 104 1.8 (0.4; 8.1) 5.8 ( 2.2; 14.7) 0.7 ( 0.3; 1.1) 1.62 Age + sex: 06-11 mo.Female 89.2 97 3.0 (0.8; 11.3) 4.2 ( 1.4; 11.5) 0.2 (-0.1; 0.5) 1.32 Age + sex: 12-23 mo.Female 233.5 247 3.6 (1.8; 7.2) 16.1 (11.5; 22.1) -0.7 (-0.9; -0.5) 1.37 Age + sex: 24-35 mo.Female 217.9 225 4.5 (2.3; 8.5) 22.7 (16.9; 29.7) -0.9 (-1.2; -0.6) 1.62 Age + sex: 36-47 mo.Female 188.3 206 8.7 (5.0; 14.8) 25.9 (19.5; 33.5) -1.4 (-1.6; -1.2) 1.28 Age + sex: 48-59 mo.Female 155.5 148 8.9 (4.9; 15.6) 34.0 (25.3; 43.9) -1.3 (-1.6; -1.1) 1.42 Age + sex: 00-05 mo.Male 96.9 111 3.7 (1.3; 10.2) 9.3 ( 4.5; 18.4) 0.4 ( 0.1; 0.8) 1.67 Age + sex: 06-11 mo.Male 102.4 104 1.9 (0.4; 8.4) 8.5 ( 4.2; 16.6) -0.4 (-0.7; 0.0) 1.55 Age + sex: 12-23 mo.Male 259.8 265 6.2 (3.6; 10.4) 22.5 (17.1; 29.1) -1.1 (-1.2; -0.9) 1.41 Age + sex: 24-35 mo.Male 245.7 253 9.8 (6.1; 15.4) 23.9 (18.3; 30.5) -1.2 (-1.4; -1.0) 1.50 Age + sex: 36-47 mo.Male 218.0 214 10.4 (6.5; 16.2) 34.2 (27.0; 42.2) -1.5 (-1.7; -1.3) 1.30 Age + sex: 48-59 mo.Male 129.1 143 11.1 (6.2; 19.0) 29.7 (21.8; 39.2) -1.3 (-1.5; -1.0) 1.53 Area: Central Gonja 87.1 86 2.5 (0.9; 7.0) 13.8 ( 7.9; 23.1) -0.7 (-1.1; -0.3) 1.66 Area: East Gonja 102.0 101 7.4 (3.5; 14.7) 19.7 (12.8; 29.2) -0.4 (-0.7; -0.1) 1.61 Area: East Mamprusi 183.1 198 6.3 (2.8; 13.5) 20.8 (13.6; 30.3) -1.1 (-1.3; -0.8) 1.40 Area: Gushegu 188.5 183 7.4 (3.8; 14.0) 25.7 (18.5; 34.4) -1.0 (-1.3; -0.7) 1.59 Area: Karaga 111.0 134 15.2 (9.2; 24.1) 31.4 (22.3; 42.2) -1.2 (-1.6; -0.8) 1.90 Area: Kpandai 114.4 125 3.6 (1.5; 8.6) 16.1 ( 9.9; 25.0) -0.6 (-0.9; -0.3) 1.60 Area: Kumbungu 263.9 276 7.5 (4.5; 12.4) 24.3 (18.8; 30.9) -1.1 (-1.3; -0.9) 1.42 Area: Nanumba North 138.8 127 4.5 (1.8; 10.7) 15.5 ( 9.8; 23.6) -0.7 (-1.0; -0.4) 1.52 Area: Nanumba South 114.9 120 7.4 (3.7; 14.4) 24.3 (16.7; 34.1) -1.2 (-1.4; -0.9) 1.32 Area: North Gonja 38.0 46 11.6 (2.7; 37.9) 22.8 ( 8.4; 48.6) -0.7 (-1.6; 0.2) 2.10 Area: Saboba 127.1 136 4.0 (1.6; 9.3) 13.4 ( 8.4; 20.7) -0.7 (-1.0; -0.5) 1.30 Area: Sagnarigu 161.1 153 2.2 (0.7; 6.6) 25.2 (18.5; 33.4) -0.8 (-1.0; -0.5) 1.46 Area: Savelugu-Nanton 103.9 114 13.8 (8.5; 21.7) 32.2 (23.8; 41.9) -1.4 (-1.7; -1.1) 1.56 Area: Tamale Metro 130.6 132 10.0 (5.7; 16.9) 21.9 (15.3; 30.4) -1.0 (-1.3; -0.7) 1.64 Area: Tolon 129.6 132 3.2 (1.2; 8.3) 16.7 (11.2; 24.1) -0.6 (-0.8; -0.3) 1.54 Area: West Gonja 49.0 54 0.7 (0.1; 4.7) 21.9 ( 9.3; 43.3) 0.0 (-0.9; 1.0) 2.22 70 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 10: HL.9-c: Prevalence of underweight children under five years of age by sex, age group and district Group Weighted N Unweighted N -3SD (95% CI)- Severe -2SD (95% CI) - Moderate z-score mean (95% CI) z-score SD All 2071.5 2150 6.5 (5.3; 7.8) 24.9 (22.8; 27.2) -1.2 (-1.3; -1.2) 1.24 Age group: 00-05 mo 208.3 218 4.6 (2.3; 9.2) 11.7 ( 7.4; 17.9) -0.4 (-0.6; -0.2) 1.46 Age group: 06-11 mo 194.4 205 5.9 (3.1; 10.8) 25.0 (18.7; 32.5) -1.2 (-1.4; -1.0) 1.30 Age group: 12-23 mo 502.1 523 6.0 (4.1; 8.9) 29.9 (25.6; 34.7) -1.4 (-1.5; -1.3) 1.16 Age group: 24-35 mo 462.6 479 7.6 (5.2; 10.9) 26.1 (21.7; 30.9) -1.3 (-1.4; -1.1) 1.29 Age group: 36-47 mo 410.8 427 7.3 (4.9; 11.0) 26.0 (21.3; 31.4) -1.4 (-1.5; -1.3) 1.07 Age group: 48-59 mo 293.3 298 5.9 (3.3; 10.2) 22.3 (16.9; 28.8) -1.3 (-1.5; -1.2) 1.09 Sex: Female 1005.6 1044 6.5 (4.9; 8.5) 22.0 (19.1; 25.1) -1.1 (-1.2; -1.0) 1.24 Sex: Male 1065.9 1106 6.4 (4.9; 8.3) 27.7 (24.7; 30.9) -1.3 (-1.4; -1.2) 1.23 Age + sex: 00-05 mo.Female 107.3 105 2.1 (0.5; 7.8) 6.3 ( 2.6; 14.5) -0.3 (-0.5; 0.0) 1.28 Age + sex: 06-11 mo.Female 91.3 100 3.4 (1.0; 11.1) 17.6 (10.5; 28.1) -0.8 (-1.1; -0.6) 1.25 Age + sex: 12-23 mo.Female 237.8 252 5.3 (3.0; 9.1) 23.4 (18.0; 29.9) -1.2 (-1.3; -1.0) 1.18 Age + sex: 24-35 mo.Female 217.9 225 8.9 (5.2; 14.7) 23.1 (17.3; 30.1) -1.2 (-1.5; -1.0) 1.31 Age + sex: 36-47 mo.Female 191.3 210 8.4 (4.8; 14.3) 27.5 (20.8; 35.3) -1.3 (-1.5; -1.2) 1.14 Age + sex: 48-59 mo.Female 160.1 152 7.4 (3.5; 14.9) 24.9 (17.1; 34.8) -1.4 (-1.6; -1.2) 1.04 Age + sex: 00-05 mo.Male 100.9 113 7.3 (3.2; 15.9) 17.4 (10.4; 27.8) -0.6 (-0.9; -0.2) 1.62 Age + sex: 06-11 mo.Male 103.1 105 8.1 (3.9; 16.2) 31.5 (22.2; 42.5) -1.5 (-1.7; -1.2) 1.27 Age + sex: 12-23 mo.Male 264.3 271 6.7 (3.8; 11.4) 35.8 (29.4; 42.7) -1.6 (-1.7; -1.4) 1.10 Age + sex: 24-35 mo.Male 244.7 254 6.4 (3.8; 10.7) 28.8 (22.7; 35.6) -1.3 (-1.5; -1.2) 1.28 Age + sex: 36-47 mo.Male 219.5 217 6.4 (3.4; 11.6) 24.8 (18.6; 32.3) -1.4 (-1.6; -1.3) 1.01 Age + sex: 48-59 mo.Male 133.2 146 4.0 (1.7; 9.2) 19.2 (12.8; 27.7) -1.2 (-1.4; -0.9) 1.14 Area: Central Gonja 89.5 88 5.0 (2.3; 10.5) 20.1 (12.7; 30.5) -1.1 (-1.4; -0.8) 1.28 Area: East Gonja 103.5 103 5.9 (2.6; 12.8) 20.3 (13.4; 29.4) -1.0 (-1.2; -0.7) 1.23 Area: East Mamprusi 184.3 199 7.7 (3.6; 15.8) 28.5 (20.1; 38.7) -1.4 (-1.6; -1.2) 1.14 Area: Gushegu 190.4 187 5.4 (2.6; 11.2) 28.1 (20.7; 36.9) -1.2 (-1.5; -1.0) 1.22 Area: Karaga 113.8 135 12.4 (6.8; 21.6) 30.0 (21.0; 40.8) -1.6 (-1.9; -1.3) 1.46 Area: Kpandai 117.7 130 3.4 (1.3; 8.3) 12.5 ( 7.5; 20.3) -0.8 (-1.0; -0.6) 1.20 Area: Kumbungu 268.1 281 8.3 (5.3; 13.0) 26.2 (20.7; 32.6) -1.4 (-1.6; -1.2) 1.19 Area: Nanumba North 140.7 128 1.3 (0.3; 5.1) 20.1 (13.4; 29.1) -1.0 (-1.2; -0.8) 1.08 Area: Nanumba South 116.1 122 8.3 (4.3; 15.5) 30.7 (22.0; 41.0) -1.6 (-1.8; -1.4) 1.05 Area: North Gonja 36.3 46 7.1 (3.2; 15.4) 26.3 (12.0; 48.3) -0.9 (-1.6; -0.3) 1.52 Area: Saboba 129.8 138 4.0 (1.5; 10.0) 16.0 (10.6; 23.4) -0.9 (-1.2; -0.6) 1.37 Area: Sagnarigu 162.0 154 6.9 (3.7; 12.7) 34.9 (27.3; 43.4) -1.3 (-1.5; -1.1) 1.18 Area: Savelugu-Nanton 107.9 118 6.5 (3.1; 13.1) 28.0 (20.4; 37.1) -1.3 (-1.5; -1.1) 1.23 Area: Tamale Metro 131.3 133 8.2 (4.5; 14.7) 22.8 (16.1; 31.2) -1.4 (-1.6; -1.1) 1.24 Area: Tolon 129.6 132 2.5 (0.9; 6.6) 23.2 (16.6; 31.4) -1.2 (-1.3; -1.0) 1.03 Area: West Gonja 50.6 56 13.5 (4.4; 34.8) 21.9 ( 9.5; 42.7) -0.9 (-1.6; -0.2) 1.67 71 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 11: HL.9-b: Prevalence of wasted children under five years of age by sex, age group and district Group Weighted N Unweighted N -3SD (95% CI) - Severe -2SD (95% CI) - Moderate +2SD (95% CI) +3SD (95% CI) z-score mean (95% CI) z￾score SD All 2078.3 2156 5.0 (4.0; 6.2) 18.1 (16.2; 20.1) 0.6 (0.3; 1.1) 0.2 (0.1; 0.7) -1.0 (-1.1; -1.0) 1.16 Age group: 00-05 mo 234.8 249 9.3 (6.0; 14.3) 26.1 (20.2; 32.9) 1.3 (0.4; 3.8) 0.6 (0.1; 4.2) -1.1 (-1.3; -0.9) 1.43 Age group: 06-11 mo 195.1 204 10.8 (6.9; 6.6) 31.3 (24.6; 38.8) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.5 (-1.7; -1.3) 1.15 Age group: 12-23 mo 493.8 512 6.9 (4.6; 10.1) 29.1 (24.7; 34.0) 1.3 (0.5; 3.4) 0.4 (0.1; 2.7) -1.3 (-1.4; -1.2) 1.24 Age group: 24-35 mo 455.3 472 4.3 (2.6; 7.2) 14.5 (11.0; 18.8) 0.1 (0.0; 0.8) 0.1 (0.0; 0.8) -1.0 (-1.1; -0.9) 1.06 Age group: 36-47 mo 407.1 420 0.8 (0.2; 2.8) 7.0 ( 4.4; 10.8) 0.2 (0.0; 1.3) 0.2 (0.0; 1.3) -0.7 (-0.8; -0.6) 0.98 Age group: 48-59 mo 287.1 292 1.1 (0.4; 3.3) 4.9 ( 2.9; 8.1) 0.6 (0.2; 2.5) 0.0 (0.0; 0.0) -0.8 (-0.9; -0.6) 0.92 Sex: Female 1014.4 1048 3.8 (2.7; 5.4) 15.8 (13.4; 18.6) 0.5 (0.2; 1.3) 0.2 (0.1; 0.9) -1.0 (-1.0; -0.9) 1.10 Sex: Male 1063.9 1108 6.1 (4.6; 7.9) 20.2 (17.6; 23.2) 0.7 (0.3; 1.5) 0.2 (0.0; 1.1) -1.1 (-1.2; -1.0) 1.20 Age + sex: 00-05 mo.Female 120.5 117 7.9 (4.3; 14.2) 23.2 (15.6; 33.0) 2.0 (0.6; 7.1) 1.2 (0.2; 8.0) -0.9 (-1.2; -0.6) 1.44 Age + sex: 06-11 mo.Female 92.4 100 5.0 (1.6; 14.6) 28.0 (19.0; 39.3) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.3 (-1.5; -1.1) 1.07 Age + sex: 12-23 mo.Female 233.5 247 4.7 (2.5; 8.8) 24.7 (18.9; 31.6) 1.0 (0.2; 4.3) 0.0 (0.0; 0.0) -1.1 (-1.3; -1.0) 1.22 Age + sex: 24-35 mo.Female 217.9 225 5.1 (2.5; 10.4) 14.5 ( 9.5; 21.4) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.0 (-1.2; -0.9) 1.01 Age + sex: 36-47 mo.Female 190.2 208 0.3 (0.0; 2.1) 5.7 ( 3.0; 10.6) 0.4 (0.1; 2.8) 0.4 (0.1; 2.8) -0.7 (-0.8; -0.5) 0.96 Age + sex: 48-59 mo.Female 158.3 148 1.2 (0.3; 4.8) 3.7 ( 1.6; 8.4) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -0.8 (-1.0; -0.7) 0.81 Age + sex: 00-05 mo.Male 114.4 132 0.8 (5.8; 19.4) 29.1 (20.7; 39.1) 0.4 (0.1; 3.0) 0.0 (0.0; 0.0) -1.2 (-1.5; -1.0) 1.40 Age + sex: 06-11 mo.Male 102.7 104 16.1 (9.9; 5.0) 34.1 (24.9; 44.7) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.7 (-1.9; -1.4) 1.19 Age + sex: 12-23 mo.Male 260.3 265 8.8 (5.3; 14.1) 33.0 (26.7; 40.1) 1.6 (0.5; 5.3) 0.7 (0.1; 5.0) -1.5 (-1.6; -1.3) 1.25 Age + sex: 24-35 mo.Male 237.4 247 3.6 (1.8; 7.1) 14.5 (10.1; 20.3) 0.2 (0.0; 1.6) 0.2 (0.0; 1.6) -1.0 (-1.2; -0.9) 1.11 Age + sex: 36-47 mo.Male 216.8 212 1.3 (0.3; 5.3) 8.1 ( 4.4; 14.5) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -0.8 (-1.0; -0.6) 0.99 Age + sex: 48-59 mo.Male 128.8 144 1.0 (0.2; 5.4) 6.3 ( 3.2; 11.9) 1.4 (0.3; 5.4) 0.0 (0.0; 0.0) -0.6 (-0.8; -0.5) 1.04 Area: Central Gonja 89.6 89 1.3 (0.3; 5.3) 8.7 ( 4.3; 16.9) 1.0 (0.1; 6.5) 0.0 (0.0; 0.0) -1.0 (-1.2; -0.8) 0.93 Area: East Gonja 103.5 103 6.3 (2.9; 12.9) 17.3 (11.1; 26.1) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.2 (-1.4; -0.9) 1.09 Area: East Mamprusi 185.2 200 4.8 (2.2; 10.3) 18.6 (11.8; 28.1) 0.3 (0.0; 2.0) 0.3 (0.0; 2.0) -1.2 (-1.4; -1.0) 1.17 Area: Gushegu 191.1 184 2.1 (0.6; 7.0) 10.3 ( 6.1; 16.8) 2.0 (0.6; 6.5) 0.0 (0.0; 0.0) -0.9 (-1.1; -0.7) 1.10 Area: Karaga 115.9 136 7.6 (3.6; 15.4) 24.3 (16.2; 34.8) 0.4 (0.1; 3.0) 0.0 (0.0; 0.0) -1.1 (-1.3; -0.9) 1.20 Area: Kpandai 115.0 125 3.8 (1.5; 9.4) 11.9 ( 7.0; 19.7) 1.3 (0.2; 8.4) 1.3 (0.2; 8.4) -0.6 (-0.9; -0.4) 1.27 Area: Kumbungu 269.7 281 5.1 (2.9; 8.9) 20.2 (15.3; 26.3) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.0 (-1.2; -0.9) 1.18 Area: Nanumba North 138.3 127 3.0 (1.0; 8.8) 15.8 ( 9.9; 24.2) 1.4 (0.2; 9.1) 1.4 (0.2; 9.1) -0.9 (-1.1; -0.7) 1.12 Area: Nanumba South 114.1 119 4.0 (1.2; 12.6) 26.2 (17.7; 37.0) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.3 (-1.5; -1.0) 1.11 Area: North Gonja 43.7 57 1.3 (0.3; 5.4) 16.3 ( 6.3; 35.9) 1.1 (0.2; 7.9) 0.0 (0.0; 0.0) -0.9 (-1.4; -0.5) 1.15 Area: Saboba 130.6 139 3.8 (1.5; 9.4) 12.8 ( 7.8; 20.3) 0.6 (0.1; 4.1) 0.6 (0.1; 4.1) -0.9 (-1.1; -0.7) 1.12 Area: Sagnarigu 162.5 155 7.7 (4.2; 13.6) 27.5 (20.6; 35.6) 0.6 (0.1; 3.9) 0.0 (0.0; 0.0) -1.3 (-1.5; -1.1) 1.15 Area: Savelugu-Nanton 104.7 115 7.0 (3.2; 14.5) 19.4 (12.9; 28.1) 0.7 (0.1; 4.7) 0.0 (0.0; 0.0) -1.0 (-1.2; -0.7) 1.27 Area: Tamale Metro 131.7 135 4.9 (2.2; 10.6) 17.5 (11.5; 25.6) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.1 (-1.3; -0.9) 1.04 Area: Tolon 128.9 131 6.4 (3.2; 12.4) 20.1 (14.0; 28.0) 0.0 (0.0; 0.0) 0.0 (0.0; 0.0) -1.2 (-1.4; -1.0) 1.12 Area: West Gonja 53.8 60 13.0 (4.3; 3.0) 17.8 ( 7.7; 35.8) 1.4 (0.2; 9.1) 0.0 (0.0; 0.0) -1.2 (-1.7; -0.7) 1.41 72 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.1.2.1: Percent (%) of households who state they are more financially secure (By Type of Household and District) Table 12: Financial Security by type of HH and district Financial Security by Type of Household Type of household Total Female headed Male headed (Adult male only no adult female) Male headed (Male and female adults) Child headed (Age under 18, no adults) Household's Financial Security Status Not Financially Secure 45 84 524 0 653 29.2% 29.9% 31.2% 0.0% 30.9% Financially Secure 109 197 1156 1 1463 70.8% 70.1% 68.8% 100.0% 69.1% Total 154 281 1680 1 2116 100.0% 100.0% 100.0% 100.0% 100.0% Financial Security by District Household's Financial Security Status Total Not Financially Secure Financially Secure District Central Gonja 36 97 133 27.1% 72.9% 100.0% East Gonja 46 105 151 30.5% 69.5% 100.0% East Mamprusi 35 74 109 32.1% 67.9% 100.0% Gushegu 74 101 175 42.3% 57.7% 100.0% Karaga 17 107 124 13.7% 86.3% 100.0% Kpandai 73 72 145 50.3% 49.7% 100.0% Kumbungu 57 81 138 41.3% 58.7% 100.0% Nanumba North 35 151 186 18.8% 81.2% 100.0% Nanumba South 29 97 126 23.0% 77.0% 100.0% North Gonja 42 89 131 32.1% 67.9% 100.0% Saboba 68 97 165 41.2% 58.8% 100.0% Sagnarigu 43 64 107 40.2% 59.8% 100.0% Savelugu-Nanton 22 94 116 19.0% 81.0% 100.0% Tamale Metro 35 91 126 27.8% 72.2% 100.0% Tolon 10 90 100 10.0% 90.0% 100.0% West Gonja 30 54 84 35.7% 64.3% 100.0% Total 652 1464 2116 30.8% 69.2% 100.0% 73 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.1.3.1: Percent (%) of target households benefiting from crop intervention reporting use of techniques to reduce post-harvest losses Table 13: Post harvest reduction techniques by HH type and district Techniques used to reduce Post harvest loses Total Use Type of household Female headed 11 11 100.0% 100.0% Male headed (Adult male only no adult female) 10 10 100.0% 100.0% Male headed (Male and female adults) 144 144 100.0% 100.0% Total 165 165 100.0% 100.0% Techniques used to reduce loses during harvesting, immediately after harvesting and storage of soybeans Total Use of Purdue Improved Cowpea Storage (PICS) bags Use of improved mud silos Use of ground tarpaulins Storage on pallets Timely harvestin g, proper cleaning and drying Use of sand box Stored in jute sacks Type of HH Female headed 6 4 0 0 0 1 0 11 54.5% 36.4% 0.0% 0.0% 0.0% 9.1% 0.0% 100.0% Male headed (Adult male only no adult female) 9 0 1 0 0 0 0 10 90.0% 0.0% 10.0% 0.0% 0.0% 0.0% 0.0% 100.0% Male headed (Male and female adults) 77 42 19 2 1 1 1 143 53.8% 29.4% 13.3% 1.4% 0.7% 0.7% 0.7% 100.0% Total 92 46 20 2 1 2 1 164 56.1% 28.0% 12.2% 1.2% .6% 1.2% .6% 100.0% 74 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Techniques used to reduce loses during harvesting, immediately after harvesting and storage of soybeans Total Use of Purdue Improved Cowpea Storage (PICS) bags Use of improved mud silos Use of ground tarpaulins Storage on pallets Timely harvestin g, proper cleaning and drying Use of sand box Stored in jute sacks District Central Gonja 5 0 0 0 0 0 0 5 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% East Gonja 1 1 0 0 0 0 0 2 50.0% 50.0% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% Gushegu 2 0 1 0 0 0 0 3 66.7% 0.0% 33.3% 0.0% 0.0% 0.0% 0.0% 100.0% Karaga 5 4 3 0 0 0 0 12 41.7% 33.3% 25.0% 0.0% 0.0% 0.0% 0.0% 100.0% Kpandai 9 2 2 0 0 0 0 13 69.2% 15.4% 15.4% 0.0% 0.0% 0.0% 0.0% 100.0% Kumbungu 9 0 0 0 0 0 0 9 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% Nanumba North 5 9 3 0 0 0 0 17 29.4% 52.9% 17.6% 0.0% 0.0% 0.0% 0.0% 100.0% Nanumba South 4 4 2 0 1 1 0 12 33.3% 33.3% 16.7% 0.0% 8.3% 8.3% 0.0% 100.0% North Gonja 1 0 1 0 0 0 0 2 50.0% 0.0% 50.0% 0.0% 0.0% 0.0% 0.0% 100.0% Saboba 14 2 1 0 0 0 0 17 82.4% 11.8% 5.9% 0.0% 0.0% 0.0% 0.0% 100.0% Sagnarigu 3 0 0 0 0 0 0 3 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% Savelugu￾Nanton 13 9 2 1 0 1 1 27 48.1% 33.3% 7.4% 3.7% 0.0% 3.7% 3.7% 100.0% Tamale Metro 16 14 4 0 0 0 0 34 47.1% 41.2% 11.8% 0.0% 0.0% 0.0% 0.0% 100.0% Tolon 6 1 1 1 0 0 0 9 66.7% 11.1% 11.1% 11.1% 0.0% 0.0% 0.0% 100.0% West Gonja 0 0 0 0 0 0 0 0 Total 93 46 20 2 1 2 1 165 56.4% 27.9% 12.1% 1.2% .6% 1.2% .6% 100.0% 75 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.1.3.2: Percent (%) of target households reporting shorter lean season Table 14: HHs reporting shorter lean season by HH type and district Period household had to adjust food intake, compared to same time last year, because there was no money to buy food Total Much Shorter Shorter Remained the same Longer Much Longer No Response/DK Type of household Female headed 11 45 38 32 13 14 153 7.2% 29.4% 24.8% 20.9% 8.5% 9.2% 100.0% Male headed (Adult male only no adult female) 18 62 122 39 15 26 282 6.4% 22.0% 43.3% 13.8% 5.3% 9.2% 100.0% Male headed (Male and female adults) 187 563 458 269 129 74 1680 11.1% 33.5% 27.3% 16.0% 7.7% 4.4% 100.0% Child headed (Age under 18, no adults) 0 0 1 0 0 0 1 0.0% 0.0% 100.0% 0.0% 0.0% 0.0% 100.0% Total 216 670 619 340 157 114 2116 10.2% 31.7% 29.3% 16.1% 7.4% 5.4% 100.0% Period household had to adjust food intake, compared to same time last year, because there was no money to buy food Total Much Shorter Shorter Remained the same Longer Much Longer No Response/DK District Central Gonja 6 39 38 37 12 1 133 4.5% 29.3% 28.6% 27.8% 9.0% .8% 100.0% East Gonja 3 26 64 15 2 40 150 2.0% 17.3% 42.7% 10.0% 1.3% 26.7% 100.0% East Mamprusi 24 22 10 37 16 0 109 22.0% 20.2% 9.2% 33.9% 14.7% 0.0% 100.0% Gushegu 20 54 44 20 30 7 175 11.4% 30.9% 25.1% 11.4% 17.1% 4.0% 100.0% Karaga 15 56 35 7 8 3 124 12.1% 45.2% 28.2% 5.6% 6.5% 2.4% 100.0% Kpandai 21 51 30 29 13 1 145 14.5% 35.2% 20.7% 20.0% 9.0% .7% 100.0% Kumbungu 19 28 58 17 7 9 138 13.8% 20.3% 42.0% 12.3% 5.1% 6.5% 100.0% Nanumba North 8 72 72 16 11 6 185 4.3% 38.9% 38.9% 8.6% 5.9% 3.2% 100.0% Nanumba South 17 25 13 43 15 12 125 13.6% 20.0% 10.4% 34.4% 12.0% 9.6% 100.0% North Gonja 5 53 58 13 1 1 131 3.8% 40.5% 44.3% 9.9% .8% .8% 100.0% Saboba 5 72 41 36 11 0 165 3.0% 43.6% 24.8% 21.8% 6.7% 0.0% 100.0% Sagnarigu 13 37 20 18 7 12 107 12.1% 34.6% 18.7% 16.8% 6.5% 11.2% 100.0% Savelugu-Nanton 13 39 34 13 4 13 116 11.2% 33.6% 29.3% 11.2% 3.4% 11.2% 100.0% Tamale Metro 14 32 43 20 9 7 125 11.2% 25.6% 34.4% 16.0% 7.2% 5.6% 100.0% Tolon 32 29 22 7 8 2 100 32.0% 29.0% 22.0% 7.0% 8.0% 2.0% 100.0% West Gonja 0 34 37 11 1 0 83 0.0% 41.0% 44.6% 13.3% 1.2% 0.0% 100.0% Total 215 669 619 339 155 114 2111 10.2% 31.7% 29.3% 16.1% 7.3% 5.4% 100.0% 76 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 15: HHs reporting a reduction food consumption last year by HH type and district Whether there were times in the last year HH reduced the quantity of food they eat By Type of Household Yes No Refused Total Type of household Female headed 122 32 0 154 79.2% 20.8% 0.0% 100.0% Male headed (Adult male only no adult female) 204 76 1 281 72.6% 27.0% .4% 100.0% Male headed (Male and female adults) 1296 378 5 1679 77.2% 22.5% .3% 100.0% Child headed (Age under 18, no adults) 1 0 0 1 100.0% 0.0% 0.0% 100.0% Total 1623 486 6 2115 76.7% 23.0% .3% 100.0% Whether there were times in the last year HH reduced the quantity of food they eat by District Yes No Refused Total District Central Gonja 100 33 0 133 75.2% 24.8% 0.0% 100.0% East Gonja 92 58 1 151 60.9% 38.4% .7% 100.0% East Mamprusi 105 4 0 109 96.3% 3.7% 0.0% 100.0% Gushegu 153 22 0 175 87.4% 12.6% 0.0% 100.0% Karaga 111 13 0 124 89.5% 10.5% 0.0% 100.0% Kpandai 125 20 0 145 86.2% 13.8% 0.0% 100.0% Kumbungu 93 43 1 137 67.9% 31.4% .7% 100.0% Nanumba North 114 72 0 186 61.3% 38.7% 0.0% 100.0% Nanumba South 99 24 3 126 78.6% 19.0% 2.4% 100.0% North Gonja 108 23 0 131 82.4% 17.6% 0.0% 100.0% Saboba 142 23 0 165 86.1% 13.9% 0.0% 100.0% Sagnarigu 81 26 0 107 75.7% 24.3% 0.0% 100.0% Savelugu-Nanton 76 40 0 116 65.5% 34.5% 0.0% 100.0% Tamale Metro 86 40 0 126 68.3% 31.7% 0.0% 100.0% Tolon 64 36 0 100 64.0% 36.0% 0.0% 100.0% West Gonja 74 10 0 84 88.1% 11.9% 0.0% 100.0% Total 1623 487 5 2115 76.7% 23.0% .2% 100.0% 77 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 16: Number of months HH adjusted food intake by district Number of months adjusted food intake last year Total 1 2 3 4 5 6 District Central Gonja 6 39 38 37 12 1 133 4.5% 29.3% 28.6% 27.8% 9.0% .8% 100.0% East Gonja 3 26 64 15 2 40 150 2.0% 17.3% 42.7% 10.0% 1.3% 26.7% 100.0% East Mamprusi 24 22 10 37 16 0 109 22.0% 20.2% 9.2% 33.9% 14.7% 0.0% 100.0% Gushegu 20 54 44 20 30 7 175 11.4% 30.9% 25.1% 11.4% 17.1% 4.0% 100.0% Karaga 15 56 35 7 8 3 124 12.1% 45.2% 28.2% 5.6% 6.5% 2.4% 100.0% Kpandai 21 51 30 29 13 1 145 14.5% 35.2% 20.7% 20.0% 9.0% .7% 100.0% Kumbungu 19 28 58 17 7 9 138 13.8% 20.3% 42.0% 12.3% 5.1% 6.5% 100.0% Nanumba North 8 72 72 16 11 6 185 4.3% 38.9% 38.9% 8.6% 5.9% 3.2% 100.0% Nanumba South 17 25 13 43 15 12 125 13.6% 20.0% 10.4% 34.4% 12.0% 9.6% 100.0% North Gonja 5 53 58 13 1 1 131 3.8% 40.5% 44.3% 9.9% .8% .8% 100.0% Saboba 5 72 41 36 11 0 165 3.0% 43.6% 24.8% 21.8% 6.7% 0.0% 100.0% Sagnarigu 13 37 20 18 7 12 107 12.1% 34.6% 18.7% 16.8% 6.5% 11.2% 100.0% Savelugu-Nanton 13 39 34 13 4 13 116 11.2% 33.6% 29.3% 11.2% 3.4% 11.2% 100.0% Tamale Metro 14 32 43 20 9 7 125 11.2% 25.6% 34.4% 16.0% 7.2% 5.6% 100.0% Tolon 32 29 22 7 8 2 100 32.0% 29.0% 22.0% 7.0% 8.0% 2.0% 100.0% West Gonja 0 34 37 11 1 0 83 0.0% 41.0% 44.6% 13.3% 1.2% 0.0% 100.0% Total 215 669 619 339 155 114 2111 10.2% 31.7% 29.3% 16.1% 7.3% 5.4% 100.0% 78 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.1.3.6: Percent (%) of targeted households who have increased their income through RING supported activities Table 17: Change in household income as a result of RING by HH type and district Change in household income as a result of ring Total Remained the same increased/more diversified Decreased Don't Know/Can’t Tell Type of household Female headed 30 115 3 6 154 19.5% 74.7% 1.9% 3.9% 100.0% Male headed (Adult male only no adult female) 55 215 0 12 282 19.5% 76.2% 0.0% 4.3% 100.0% Male headed (Male and female adults) 356 1280 21 23 1680 21.2% 76.2% 1.3% 1.4% 100.0% Child headed (Age under 18, no adults) 2 0 0 0 2 100.0% 0.0% 0.0% 0.0% 100.0% Total 443 1610 24 41 2118 20.9% 76.0% 1.1% 1.9% 100.0% Change in household income as a result of ring Total Remained the same increased/more diversified Decreased Don't Know/Can’t Tell District Central Gonja 10 121 0 2 133 7.5% 91.0% 0.0% 1.5% 100.0% East Gonja 32 116 0 2 150 21.3% 77.3% 0.0% 1.3% 100.0% East Mamprusi 27 79 0 3 109 24.8% 72.5% 0.0% 2.8% 100.0% Gushegu 44 124 1 7 176 25.0% 70.5% .6% 4.0% 100.0% Karaga 9 114 0 1 124 7.3% 91.9% 0.0% .8% 100.0% Kpandai 42 89 10 4 145 29.0% 61.4% 6.9% 2.8% 100.0% Kumbungu 43 81 6 8 138 31.2% 58.7% 4.3% 5.8% 100.0% Nanumba North 53 130 2 0 185 28.6% 70.3% 1.1% 0.0% 100.0% Nanumba South 24 96 0 6 126 19.0% 76.2% 0.0% 4.8% 100.0% North Gonja 25 104 1 2 132 18.9% 78.8% .8% 1.5% 100.0% Saboba 26 138 0 1 165 15.8% 83.6% 0.0% .6% 100.0% Sagnarigu 19 85 0 3 107 17.8% 79.4% 0.0% 2.8% 100.0% Savelugu-Nanton 11 103 1 1 116 9.5% 88.8% .9% .9% 100.0% Tamale Metro 23 102 1 1 127 18.1% 80.3% .8% .8% 100.0% Tolon 23 74 3 0 100 23.0% 74.0% 3.0% 0.0% 100.0% West Gonja 31 53 0 0 84 36.9% 63.1% 0.0% 0.0% 100.0% Total 442 1609 25 41 2117 20.9% 76.0% 1.2% 1.9% 100.0% 79 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project 1.1.3.2: % of target households reporting shorter lean season Table 18: HHs reporting shorter lean period by HH type and district Period household had to adjust food intake, compared to same time last year, because there was no money to buy food Total Much Shorter Shorter Remained the same Longer Much Longer No Response/DK Type of household Female headed 11 45 38 32 13 14 153 7.2% 29.4% 24.8% 20.9% 8.5% 9.2% 100.0% Male headed (Adult male only no adult female) 18 62 122 39 15 26 282 6.4% 22.0% 43.3% 13.8% 5.3% 9.2% 100.0% Male headed (Male and female adults) 187 563 458 269 129 74 1680 11.1% 33.5% 27.3% 16.0% 7.7% 4.4% 100.0% Child headed (Age under 18, no adults) 0 0 1 0 0 0 1 0.0% 0.0% 100.0% 0.0% 0.0% 0.0% 100.0% Total 216 670 619 340 157 114 2116 10.2% 31.7% 29.3% 16.1% 7.4% 5.4% 100.0% Period household had to adjust food intake, compared to same time last year, because there was no money to buy food Total Much Shorter Shorter Remained the same Longer Much Longer No Response/DK District Central Gonja 6 39 38 37 12 1 133 4.5% 29.3% 28.6% 27.8% 9.0% .8% 100.0% East Gonja 3 26 64 15 2 40 150 2.0% 17.3% 42.7% 10.0% 1.3% 26.7% 100.0% East Mamprusi 24 22 10 37 16 0 109 22.0% 20.2% 9.2% 33.9% 14.7% 0.0% 100.0% Gushegu 20 54 44 20 30 7 175 11.4% 30.9% 25.1% 11.4% 17.1% 4.0% 100.0% Karaga 15 56 35 7 8 3 124 12.1% 45.2% 28.2% 5.6% 6.5% 2.4% 100.0% Kpandai 21 51 30 29 13 1 145 14.5% 35.2% 20.7% 20.0% 9.0% .7% 100.0% Kumbungu 19 28 58 17 7 9 138 13.8% 20.3% 42.0% 12.3% 5.1% 6.5% 100.0% Nanumba North 8 72 72 16 11 6 185 4.3% 38.9% 38.9% 8.6% 5.9% 3.2% 100.0% Nanumba South 17 25 13 43 15 12 125 13.6% 20.0% 10.4% 34.4% 12.0% 9.6% 100.0% North Gonja 5 53 58 13 1 1 131 3.8% 40.5% 44.3% 9.9% .8% .8% 100.0% Saboba 5 72 41 36 11 0 165 3.0% 43.6% 24.8% 21.8% 6.7% 0.0% 100.0% Sagnarigu 13 37 20 18 7 12 107 12.1% 34.6% 18.7% 16.8% 6.5% 11.2% 100.0% Savelugu-Nanton 13 39 34 13 4 13 116 11.2% 33.6% 29.3% 11.2% 3.4% 11.2% 100.0% Tamale Metro 14 32 43 20 9 7 125 11.2% 25.6% 34.4% 16.0% 7.2% 5.6% 100.0% Tolon 32 29 22 7 8 2 100 32.0% 29.0% 22.0% 7.0% 8.0% 2.0% 100.0% West Gonja 0 34 37 11 1 0 83 0.0% 41.0% 44.6% 13.3% 1.2% 0.0% 100.0% Total 215 669 619 339 155 114 2111 10.2% 31.7% 29.3% 16.1% 7.3% 5.4% 100.0% 80 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.2.1: Percent (%) of households adopting improved nutrition practices Table 19: Percentage of HHs reporting improved nutrition practices by HH type and district Improved Nutritional Practices Total Type of household Female headed 62 62 100.0% 100.0% Male headed (Adult male only no adult female) 148 148 100.0% 100.0% Male headed (Male and female adults) 950 950 100.0% 100.0% Child headed (Age under 18, no adults) 0 0 Total 1160 1160 100.0% 100.0% Improved nutritional practices Total Improved Nutritional Practices District Central Gonja 52 52 100.0% 100.0% East Gonja 72 72 100.0% 100.0% East Mamprusi 84 84 100.0% 100.0% Gushegu 87 87 100.0% 100.0% Karaga 68 68 100.0% 100.0% Kpandai 70 70 100.0% 100.0% Kumbungu 111 111 100.0% 100.0% Nanumba North 100 100 100.0% 100.0% Nanumba South 61 61 100.0% 100.0% North Gonja 38 38 100.0% 100.0% Saboba 83 83 100.0% 100.0% Sagnarigu 75 75 100.0% 100.0% Savelugu-Nanton 64 64 100.0% 100.0% Tamale Metro 78 78 100.0% 100.0% Tolon 72 72 100.0% 100.0% West Gonja 45 45 100.0% 100.0% Total 1160 1160 100.0% 100.0% 81 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 20: Number of nutrition practices adopted by HH type and district Numbr_of_practices_Rec * Type of household Numbr_of_practices_Rec Type of household N Mean Median Minimum Maximum Female headed 62 8.70 9.00 2.00 13.00 Male headed (Adult male only no adult female) 148 8.89 9.00 3.00 13.00 Male headed (Male and female adults) 950 9.76 10.00 2.00 13.00 Child headed (Age under 18, no adults) 10.00 10.00 10.00 10.00 Total 1160 9.59 10.00 2.00 13.00 Numbr_of_practices_Rec * District Numbr_of_practices_Rec District N Mean Median Minimum Maximum Central Gonja 52 9.9384 10.00 6.00 13.00 East Gonja 72 9.10 9.00 2.00 13.00 East Mamprusi 84 10.66 10.81 8.00 13.00 Gushegu 87 8.34 8.97 3.00 13.00 Karaga 68 9.14 9.00 5.00 12.00 Kpandai 70 9.52 10.00 3.00 12.00 Kumbungu 111 9.63 10.00 6.00 12.00 Nanumba North 100 9.31 10.00 2.00 13.00 Nanumba South 61 9.18 10.00 2.00 13.00 North Gonja 38 9.19 9.95 3.00 13.00 Saboba 83 11.21 11.00 8.00 13.00 Sagnarigu 75 10.01 10.00 5.00 13.00 Savelugu-Nanton 64 9.57 9.47 5.00 13.00 Tamale Metro 78 9.54 9.34 6.00 13.00 Tolon 72 9.25 10.00 4.00 12.00 West Gonja 45 9.72 10.00 4.00 13.00 Total 1160 9.59 10.00 2.00 13.00 82 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.2.1.1: Percent (%) of respondents in target communities knowledgeable of appropriate infant and young child feeding practices Table 21: Knowledge of appropriate IYCF practices by HH type and district Type of household * IYCF knowledge IYCF Knowledge Total Knowledgeable Type of household Female headed 14 14 100.0% 100.0% Male headed (Adult male only no adult female) 32 32 100.0% 100.0% Male headed (Male and female adults) 277 277 100.0% 100.0% Child headed (Age under 18, no adults) 0 0 Total 323 323 100.0% 100.0% District * IYCF Knowledge IYCF knowledge Total Knowledgeable District Central Gonja 12 12 100.0% 100.0% East Gonja 16 16 100.0% 100.0% East Mamprusi 36 36 100.0% 100.0% Gushegu 20 20 100.0% 100.0% Karaga 24 24 100.0% 100.0% Kpandai 11 11 100.0% 100.0% Kumbungu 49 49 100.0% 100.0% Nanumba North 27 27 100.0% 100.0% Nanumba South 9 9 100.0% 100.0% North Gonja 2 2 100.0% 100.0% Saboba 14 14 100.0% 100.0% Sagnarigu 27 27 100.0% 100.0% Savelugu-Nanton 17 17 100.0% 100.0% Tamale Metro 25 25 100.0% 100.0% Tolon 27 27 100.0% 100.0% West Gonja 8 8 100.0% 100.0% Total 324 324 100.0% 100.0% 83 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project 1.2.1.2: Number of service delivery channels that mainstream appropriate nutrition messages throughout the community Table 22: Number of service delivery channels reported to mainstream appropriate nutrition messages by HH type and district mainstream_Service_Delivery * Type of household mainstream _Service_Delivery Type of household N Mean Median Minimum Maximum Female headed 154 5.39 5.00 1.00 13.00 Male headed (Adult male only no adult female) 281 6.32 6.00 1.00 13.00 Male headed (Male and female adults) 1679 5.31 5.00 1.00 14.00 Child headed (Age under 18, no adults) 2 2.24 2.21 2.00 3.00 Total 2116 5.45 5.00 1.00 14.00 mainstream _Service Delivery * District Improved_Service_Delivery District N Mean Median Minimum Maximum Central Gonja 133 3.50 3.00 1.00 7.00 East Gonja 151 5.16 5.00 1.00 13.00 East Mamprusi 109 7.40 7.00 2.00 13.00 Gushegu 175 5.56 5.00 1.00 11.00 Karaga 124 5.30 5.00 1.00 12.00 Kpandai 145 2.77 2.00 1.00 8.00 Kumbungu 138 4.39 4.10 1.00 11.00 Nanumba North 186 5.65 5.00 1.00 13.00 Nanumba South 127 6.26 6.00 1.00 13.00 North Gonja 131 4.21 5.00 1.00 8.00 Saboba 165 7.11 7.00 1.00 13.00 Sagnarigu 107 7.23 7.00 1.00 14.00 Savelugu-Nanton 116 7.32 7.00 1.00 13.00 Tamale Metro 126 5.85 5.00 1.00 13.00 Tolon 100 5.61 6.00 1.00 12.00 West Gonja 84 4.25 5.00 1.00 9.00 Total 2116 5.45 5.00 1.00 14.00 84 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project HL.9.1-c: Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age (WRA) Table 23: Women dietary diversity by district # of Food groups Freq Percent 1 14 1.18 2 89 7.47 3 251 21.07 4 356 29.89 5 268 22.5 6 128 10.75 7 45 3.78 8 24 2.02 9 16 1.34 Mean WDD 4.26 Total 1,191 100 DDS_DEFINED Frequency Percent Diversified diet (5 or more food groups) 481 40.4 not diversified 711 59.6 Total 1192 100.0 Diversified diet not diversified Total Freq Percent Freq Percent Freq Percent District Central Gonja 30 54.5 25 45.5 55 100.0 East Gonja 35 47.3 39 52.7 74 100.0 East Mamprusi 67 72.0 26 28.0 93 100.0 Gushegu 39 41.1 56 58.9 95 100.0 Karaga 52 69.3 23 30.7 75 100.0 Kpandai 12 15.8 64 84.2 76 100.0 Kumbungu 33 29.7 78 70.3 111 100.0 Nanumba North 16 21.6 58 78.4 74 100.0 Nanumba South 17 24.3 53 75.7 70 100.0 North Gonja 14 28.6 35 71.4 49 100.0 Saboba 38 46.3 44 53.7 82 100.0 Sagnarigu 27 36.0 48 64.0 75 100.0 Savelugu-Nanton 32 48.5 34 51.5 66 100.0 Tamale Metro 23 28.8 57 71.3 80 100.0 Tolon 26 35.6 47 64.4 73 100.0 West Gonja 20 45.5 24 54.5 44 100.0 Total 481 40.4 711 59.6 1192 100.0 85 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project HL.9.1-a: Prevalence of children 6-23 months receiving a minimum acceptable diet Table 24: Percentage of children who met minimum acceptable diet Minimum acceptable diet (MAD) Frequency Percentage Met MAD 56 64.37 Did not meet MAD 31 35.63 Total 87 100 Table 25: Minimum dietary diversity for children 6-23 months Minimum dietary diversity (MAD) Frequency Percentage Met MDD 383 95.51 Did not meet MDD 18 4.49 Total 401 100.0 HL.9.1-b: Prevalence of exclusive breastfeeding of children under six months of age Table 26: Prevalence of exclusive breastfeeding of children under six months of age by HH type and district Other foods given to child before he/she was six months old Total No food apart from breast milk (exclusively breastfed) Other food & drinks (water, koko, infant milk etc) Child less than 6 months DK/NA Type of household Female headed 42 16 4 0 62 67.7% 25.8% 6.5% 0.0% 100.0% Male headed (Adult male only no adult female) 94 41 8 5 148 63.5% 27.7% 5.4% 3.4% 100.0% Male headed (Male and female adults) 716 192 37 5 950 75.4% 20.2% 3.9% .5% 100.0% Child headed (Age under 18, no adults) 0 0 0 0 0 Total 852 249 49 10 1160 73.4% 21.5% 4.2% .9% 100.0% 86 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Exclusive breastfeeding by District Other foods given to child before he/she was six months old Total No food apart from breast milk (exclusively breastfed) Other food & drinks (water, koko, infant milk etc) Child less than 6 months DK/NA District Central Gonja 40 8 2 2 52 76.9% 15.4% 3.8% 3.8% 100.0% East Gonja 55 11 4 2 72 76.4% 15.3% 5.6% 2.8% 100.0% East Mamprusi 76 2 5 0 83 91.6% 2.4% 6.0% 0.0% 100.0% Gushegu 58 25 3 1 87 66.7% 28.7% 3.4% 1.1% 100.0% Karaga 59 7 0 1 67 88.1% 10.4% 0.0% 1.5% 100.0% Kpandai 38 31 1 0 70 54.3% 44.3% 1.4% 0.0% 100.0% Kumbungu 84 17 10 0 111 75.7% 15.3% 9.0% 0.0% 100.0% Nanumba North 70 26 3 0 99 70.7% 26.3% 3.0% 0.0% 100.0% Nanumba South 43 14 3 1 61 70.5% 23.0% 4.9% 1.6% 100.0% North Gonja 24 12 2 0 38 63.2% 31.6% 5.3% 0.0% 100.0% Saboba 73 6 4 0 83 88.0% 7.2% 4.8% 0.0% 100.0% Sagnarigu 59 15 1 0 75 78.7% 20.0% 1.3% 0.0% 100.0% Savelugu￾Nanton 48 13 1 2 64 75.0% 20.3% 1.6% 3.1% 100.0% Tamale Metro 55 19 4 0 78 70.5% 24.4% 5.1% 0.0% 100.0% Tolon 52 17 3 0 72 72.2% 23.6% 4.2% 0.0% 100.0% West Gonja 17 26 2 0 45 37.8% 57.8% 4.4% 0.0% 100.0% Total 851 249 48 9 1157 73.6% 21.5% 4.1% .8% 100.0% 87 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project HL.8.2-5: Percentage of households with soap and water at a handwashing station commonly used by family members Table 27: Percentage of households with soap and water at a handwashing station commonly used by family members by HH type and district handwashing_at_toilet_Rec Total Not available Soap and running water Available Type of household Female headed 5 22 27 18.5% 81.5% 100.0% Male headed (Adult male only no adult female) 8 25 33 24.2% 75.8% 100.0% Male headed (Male and female adults) 43 203 246 17.5% 82.5% 100.0% Total 56 250 306 18.3% 81.7% 100.0% handwashing_at_toilet_Rec Total Not available Soap and running water available District Central Gonja 0 21 21 0.0% 100.0% 100.0% East Gonja 1 29 30 3.3% 96.7% 100.0% East Mamprusi 2 10 12 16.7% 83.3% 100.0% Gushegu 12 42 54 22.2% 77.8% 100.0% Karaga 4 7 11 36.4% 63.6% 100.0% Kpandai 1 35 36 2.8% 97.2% 100.0% Kumbungu 1 1 2 50.0% 50.0% 100.0% Nanumba North 16 39 55 29.1% 70.9% 100.0% Nanumba South 3 3 6 50.0% 50.0% 100.0% North Gonja 0 4 4 0.0% 100.0% 100.0% Saboba 6 35 41 14.6% 85.4% 100.0% Sagnarigu 0 1 1 0.0% 100.0% 100.0% Savelugu-Nanton 7 18 25 28.0% 72.0% 100.0% Tolon 0 2 2 0.0% 100.0% 100.0% West Gonja 0 3 3 0.0% 100.0% 100.0% Total 53 250 303 17.5% 82.5% 100.0% 88 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 28: Availability of handwashing facilities by HH type and district Availability of handwashing facility Total No handwashing facility Handwashing facility available Type of household Female headed 57 27 84 67.90% 32.10% 100.00% Male headed (Adult male only no adult female) 63 33 96 65.60% 34.40% 100.00% Male headed (Male and female adults) 444 249 693 64.10% 35.90% 100.00% Total 564 309 873 64.60% 35.40% 100.00% Availability of handwashing facility Total No handwashing facility Handwashing facility available District Central Gonja 45 21 66 68.20% 31.90% 100.00% East Gonja 38 30 68 55.90% 44.10% 100.00% East Mamprusi 80 12 92 87.00% 13.00% 100.00% Gushegu 75 55 130 57.70% 42.30% 100.00% Karaga 31 11 42 73.80% 26.20% 100.00% Kpandai 31 36 67 46.30% 53.70% 100.00% Kumbungu 18 1 19 94.70% 5.30% 100.00% Nanumba North 65 59 124 52.40% 47.60% 100.00% Nanumba South 13 6 19 68.40% 31.60% 100.00% North Gonja 19 4 23 82.60% 17.40% 100.00% Saboba 69 41 110 62.70% 37.30% 100.00% Sagnarigu 8 1 9 88.90% 11.10% 100.00% Savelugu-Nanton 28 26 54 51.90% 48.10% 100.00% Tamale Metro 7 0 7 100.00% 0.00% 100.00% Tolon 26 2 28 92.90% 7.10% 100.00% West Gonja 12 3 15 80.00% 20.00% 100.00% Total 565 308 873 64.70% 35.40% 100.00% 89 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project HL.8.2-6: Percentage of households in target areas practicing correct use of recommended household water treatment technologies Table 29: Percentage of HHs practicing correct use of recommended HH water treatment technologies by HH type and district MakeWaterSafe Total Incorrect use Correct use Type of household Female headed 0 41 41 0.0% 100.0% 100.0% Male headed (Adult male only no adult female) 0 62 62 0.0% 100.0% 100.0% Male headed (Male and female adults) 7 483 490 1.4% 98.6% 100.0% Child headed (Age under 18, no adults) 0 2 2 0.0% 100.0% 100.0% Total 7 588 595 1.2% 98.8% 100.0% MakeWaterSafe Total Incorrect use Correct use District Central Gonja 0 75 75 0.0% 100.0% 100.0% East Gonja 0 46 46 0.0% 100.0% 100.0% East Mamprusi 0 27 27 0.0% 100.0% 100.0% Gushegu 0 46 46 0.0% 100.0% 100.0% Karaga 2 52 54 3.7% 96.3% 100.0% Kpandai 2 27 29 6.9% 93.1% 100.0% Kumbungu 1 34 35 2.9% 97.1% 100.0% Nanumba North 1 55 56 1.8% 98.2% 100.0% Nanumba South 0 27 27 0.0% 100.0% 100.0% North Gonja 1 21 22 4.5% 95.5% 100.0% Saboba 0 26 26 0.0% 100.0% 100.0% Sagnarigu 0 15 15 0.0% 100.0% 100.0% Savelugu-Nanton 0 17 17 0.0% 100.0% 100.0% Tamale Metro 0 57 57 0.0% 100.0% 100.0% Tolon 0 42 42 0.0% 100.0% 100.0% West Gonja 0 23 23 0.0% 100.0% 100.0% 90 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 3.1.8.1-2: Percent (%) of respondents who know any 3 critical times of hand washing Table 30: Percentage of respondents who knows any 3 critical times of hand washing Knowledge of critical times of handwashing Total Know less than 3 Know at least 3 Type of household Female headed 28 126 154 18.20% 81.80% 100.00% Male headed (Adult male only no adult female) 72 209 281 25.60% 74.40% 100.00% Male headed (Male and female adults) 270 1409 1679 16.10% 83.90% 100.00% Child headed (Age under 18, no adults) 0 2 2 0.00% 100.00% 100.00% Total 370 1746 2116 17.50% 82.50% 100.00% Knowledge of critical times of handwashing Total Know less than 3 Know at least 3 District Central Gonja 32 101 133 24.10% 75.90% 100.00% East Gonja 19 132 151 12.60% 87.40% 100.00% East Mamprusi 1 107 108 0.90% 99.10% 100.00% Gushegu 62 113 175 35.40% 64.60% 100.00% Karaga 24 100 124 19.40% 80.60% 100.00% Kpandai 30 115 145 20.70% 79.30% 100.00% Kumbungu 11 127 138 8.00% 92.00% 100.00% Nanumba North 28 158 186 15.10% 84.90% 100.00% Nanumba South 26 101 127 20.50% 79.50% 100.00% North Gonja 51 80 131 38.90% 61.10% 100.00% Saboba 4 161 165 2.40% 97.60% 100.00% Sagnarigu 9 98 107 8.40% 91.60% 100.00% Savelugu-Nanton 15 101 116 12.90% 87.10% 100.00% Tamale Metro 20 106 126 15.90% 84.10% 100.00% Tolon 19 81 100 19.00% 81.00% 100.00% West Gonja 20 65 85 23.50% 76.50% 100.00% Total 371 1746 2117 17.50% 82.50% 100.00% 91 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.3.1: Percent (%) of households reporting improvements in nutrition and livelihood services from local government Table 31: Number of local government nutrition and livelihood services that recoded improvement by HH type and district Improved_Service_Delivery # of services 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total Freq 160 195 247 279 298 248 202 121 122 110 77 35 23 1 2116 Percent 7.5 9.2 11.7 13.2 14.1 11.7 9.5 5.7 5.8 5.2 3.6 1.6 1.1 0.1 100.0 Percent At least 1= 100.00% At least 2= 92.50% At least 3= 83.20% At least 4= 71.60% At least 5= 58.40% At least 6= 44.30% Numbr_Services_Seeing_Improvement * Type of household Numbr_Services_Seeing_Improvement Type of household N Mean Median Minimum Maximum Female headed 154 5.39 5.00 1.00 13.00 Male headed (Adult male only no adult female) 281 6.32 6.00 1.00 13.00 Male headed (Male and female adults) 1679 5.31 5.00 1.00 14.00 Child headed (Age under 18, no adults) 2 2.24 2.21 2.00 3.00 Total 2116 5.45 5.00 1.00 14.00 Numbr_Services_Seeing_Improvement * District Numbr_Services_Seeing_Improvement District N Mean Median Minimum Maximum Central Gonja 133 3.50 3.00 1.00 7.00 East Gonja 151 5.16 5.00 1.00 13.00 East Mamprusi 109 7.40 7.00 2.00 13.00 Gushegu 175 5.56 5.00 1.00 11.00 Karaga 124 5.30 5.00 1.00 12.00 Kpandai 145 2.77 2.00 1.00 8.00 Kumbungu 138 4.39 4.10 1.00 11.00 Nanumba North 186 5.65 5.00 1.00 13.00 Nanumba South 127 6.26 6.00 1.00 13.00 North Gonja 131 4.21 5.00 1.00 8.00 Saboba 165 7.11 7.00 1.00 13.00 Sagnarigu 107 7.23 7.00 1.00 14.00 Savelugu-Nanton 116 7.32 7.00 1.00 13.00 Tamale Metro 126 5.85 5.00 1.00 13.00 Tolon 100 5.61 6.00 1.00 12.00 West Gonja 84 4.25 5.00 1.00 9.00 Total 2116 5.45 5.00 1.00 14.00 92 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 32: Percentage of respondents who reported seeing improvement in 6 or more services by HH type and district Type of household Services seeing improvements in the past 12 months Total Mentions less than 6 Mentions 6 or more Female headed 88 66 154 57.10% 42.90% 100.00% Male headed (Adult male only no adult female) 122 159 281 43.40% 56.60% 100.00% Male headed (Male and female adults) 966 713 1679 57.50% 42.50% 100.00% Child headed (Age under 18, no adults) 2 0 2 100.00% 0.00% 100.00% Total 1178 938 2116 55.70% 44.30% 100.00% Services seeing improvements in the past 12 months Total Mentions less than 6 Mentions 6 or more District Central Gonja 121 12 133 91.00% 9.00% 100.00% East Gonja 99 52 151 65.60% 34.40% 100.00% East Mamprusi 30 78 108 27.80% 72.20% 100.00% Gushegu 88 87 175 50.30% 49.70% 100.00% Karaga 76 48 124 61.30% 38.70% 100.00% Kpandai 136 9 145 93.80% 6.20% 100.00% Kumbungu 93 45 138 67.40% 32.60% 100.00% Nanumba North 99 87 186 53.20% 46.80% 100.00% Nanumba South 60 67 127 47.20% 52.80% 100.00% North Gonja 77 54 131 58.80% 41.20% 100.00% Saboba 56 109 165 33.90% 66.10% 100.00% Sagnarigu 30 77 107 28.00% 72.00% 100.00% Savelugu-Nanton 42 74 116 36.20% 63.80% 100.00% Tamale Metro 65 61 126 51.60% 48.40% 100.00% Tolon 45 55 100 45.00% 55.00% 100.00% West Gonja 61 23 84 72.60% 27.40% 100.00% Total 1178 938 2116 55.70% 44.30% 100.00% 93 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project RING 1.3.1.8: Percentage of core RING implementing departments that use community feedback to inform planning processes for their RING Annual Work Plans and Budgets and/or District Annual Action Plans Information was collected as part of district level FGDs where participants form different departments were asked how they engage communities and use feedback during preparation of annual RING workplans. In all DAs the planning unit indicated they usually use information from the community action plans (CAPs). The CAP preparation process is driven by communities’ members and facilitated by district assembly staff. ANNEX IX: LIVELIHOOD INTERVENTIONS RESULTS - EBBS 2019 VILLAGE SAVINGS AND LOANS (VSLA) SPECIFIC REUSLTS Table 33: Sources of money for VSLA savings (multiple response) Where do you get money to save in the VSLA? % of respondents Crop production 34.5% Livestock 4.8% Petty trading (Income from my small business) 47.1% Income from my small ruminants 0% Sale of Vegetable 6.7% Small Grains 7.1% Processing 23.8% From my husband 11.2% From other family members 5.4% LEAP 2.0% Other 18.4% Table 34: Comparison of last year’s and this year’s income How was your income this year compared to last year? % of respondents Better 53.3% Same 10.6% Worse 36.1% Table 35:Uses of money from VSLA share out (multiple response) What did you use your money for after the share out? % of respondents Buy food for my family 41.3% Pay school fees for my children 20.9% Pay health care related costs 20.2% Start an income generating activity 11.3% Buy animals for livestock rearing 4.2% Buy new assets 5.6% Construct or improve latrine 0.5% Housing improvements 5.9% Land improvements 11.7% Buy farming inputs 28.8% 94 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 36: Challenges encountered as a VSLA member (multiple response) What challenges have you encountered as a VSLA member? % of respondents Lack of income to save 44.7% Lack of time to attend meetings 7.2% Difficulty in accessing loans 3.6% Lack of support from husband 2.7% Lack of support from family members 3.5% Group dynamics 9.2% Meetings keep too long 4.7% No challenge encountered 48.6 Other 3.6 Table 37: Percentage of VSLA members who took VSLA loans, amount take as loan and what it was used for Have you taken loans from your VSLA since you joined? % of respondents If Yes how much? % of respondents What did you use the loan for? % of respondents Yes 74.4% GHS20-70 14.3% Buy food for my family. 20.5% No 25.6% GHS70+-100 28.7% Pay school fees for my children. 22.7% GHS100+-200 27.1% Pay health care related costs. 29.3% GHS200+-300 10.1% Start an income generating activity 19.0% GHS300+-400 8.2% Buy animals for livestock rearing 1.1% GHS400+ 11.5% Buy new assets 1.3% Construct or improve latrine 0.2% Housing improvements 2.5% Land improvements 5.6% Buy farming inputs 18.8% Table 38: Percentage of VSLA members who will continue to be VSLA members after the current cycle ended Will you continue to be a member of this VSLA after this cycle of savings? % of respondents Yes 99.3% No 0.7% 95 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project SMALL RUMINANTS SPECIFC RESULTS Figure 9: Whether respondent was rearing small ruminants for the first time Table 39: District level results for # of small ruminants received, births and deaths # missing, sold and amount generated from sale Districts # of respond ents # of ruminants Received # of births # of deaths # missing or stolen # slaughtered for sacrifice # sold Amount generated (GHS) Central Gonja 38 113 129 97 5 3 51 4,295.00 East Gonja 15 45 5 8 0 0 0 0 East Mamprusi 2 6 0 4 0 0 1 0 Gushegu 23 65 57 44 1 0 28 3,480.00 Karaga 67 206 192 109 19 0 34 5,304.00 Kpandai 61 181 81 39 2 1 0 0 Kumbungu 3 9 4 23 0 0 3 0 Nanumba North 113 334 335 294 30 5 37 3,400.00 Nanumba South 41 123 88 117 4 9 30 4,180.00 North Gonja 12 36 14 16 0 0 2 20.00 Saboba 56 160 312 160 10 2 92 14,065.00 Sagnerigu 24 80 54 62 7 0 22 1,560.00 Savelugu 84 249 231 146 7 1 63 6,972.00 Tamale Metro 11 60 81 51 4 1 15 1,850 Tolon 66 198 286 145 8 1 73 8,935.00 West Gonja 15 45 30 42 0 0 2 350.00 96 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 40: Number of small ruminants currently available by district District N Mean Median Minimum Maximum Sum (# currently available) Central Gonja 38 2.19 1.49 0 10 83 East Gonja 15 2.79 3.00 1 4 41 East Mamprusi 2 2.46 2.00 1 6 5 Gushegu 23 2.22 2.00 0 5 52 Karaga 67 3.45 3.00 1 7 231 Kpandai 61 3.71 3.00 0 7 227 Kumbungu 3 3.33 3.92 0 9 11 Nanumba North 113 2.67 2.00 0 8 300 Nanumba South 41 1.23 0.00 0 9 50 North Gonja 12 2.59 3.00 0 4 32 Saboba 56 3.62 3.00 0 14 203 Sagnarigu 24 2.13 2.00 0 4 50 Savelugu-Nanton 84 3.26 3.00 0 10 275 Tamale Metro 11 2.95 3.00 0 7 32 Tolon 66 4.48 4.00 0 13 296 West Gonja 15 2.64 2.00 0 12 39 Total 631 3.05 3.00 0 14 1925 Table 41: Small Ruminants Management - # sick and # reported Districts # of sick animals # of sickness reported Central Gonja 22 20 East Gonja 6 6 East Mamprusi 1 1 Gushegu 16 12 Karaga 21 18 Kpandai 10 10 Kumbungu 1 2 Nanumba North 75 70 Nanumba South 29 16 North Gonja 7 4 Saboba 23 22 Sagnerigu 11 10 Savelugu 38 34 Tamale Metro 8 6 Tolon 42 42 West Gonja 11 11 97 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 42: Whether respondent households have sold animals to date by district Have you sold any of your animals to date? sold_animals? Total No Yes District Central Gonja 20 18 38 52.6% 47.4% 100.0% East Gonja 14 1 15 93.3% 6.7% 100.0% East Mamprusi 1 1 2 50.0% 50.0% 100.0% Gushegu 6 17 23 26.1% 73.9% 100.0% Karaga 39 28 67 58.2% 41.8% 100.0% Kpandai 61 0 61 100.0% 0.0% 100.0% Kumbungu 2 1 3 66.7% 33.3% 100.0% Nanumba North 85 27 112 75.9% 24.1% 100.0% Nanumba South 24 16 40 60.0% 40.0% 100.0% North Gonja 12 1 13 92.3% 7.7% 100.0% Saboba 21 35 56 37.5% 62.5% 100.0% Sagnarigu 14 9 23 60.9% 39.1% 100.0% Savelugu-Nanton 59 25 84 70.2% 29.8% 100.0% Tamale Metro 5 5 10 50.0% 50.0% 100.0% Tolon 28 38 66 42.4% 57.6% 100.0% West Gonja 14 1 15 93.3% 6.7% 100.0% Total 405 223 628 64.5% 35.5% 100.0% 98 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 43: Number of small ruminants sold by district Number of animals (ruminants) sold no_ruminants_sold District N Mean Median Minimum Maximum Sum Central Gonja 18 3.10 3.00 1 7 54 East Mamprusi 2 2.00 2.08 1 6 3 Gushegu 17 1.56 2.00 1 2 27 Karaga 28 1.19 1.00 1 3 34 Kpandai 1.00 1.00 1 1 Kumbungu 1 1.63 1.95 1 3 2 Nanumba North 32 1.20 1.00 1 2 38 Nanumba South 16 1.74 1.75 1 4 29 North Gonja 1 2.00 2.00 2 2 1 Saboba 35 2.49 2.00 1 6 88 Sagnarigu 12 1.89 1.00 1 4 22 Savelugu-Nanton 26 2.42 1.00 1 10 64 Tamale Metro 5 1.90 1.50 1 5 10 Tolon 37 1.94 2.00 1 5 72 West Gonja 1 2.00 2.00 2 2 2 Total 232 1.92 1.00 1 10 447 99 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 44: Amount generated from small ruminant sale by district Amount generated from sale of ruminants District N Mean Median Minimum Maximum Sum Central Gonja 18 304.58 250.00 70 700 5351 East Mamprusi 1 156.67 229.03 20 300 229 Gushegu 17 226.62 250.00 55 330 3903 Karaga 28 179.37 150.00 80 450 5038 Kpandai 150.00 150.00 150 150 55 Kumbungu 1 171.43 230.33 100 290 211 Nanumba North 27 143.24 110.30 50 450 3933 Nanumba South 16 243.37 200.00 85 530 3999 North Gonja 1 20.00 20.00 20 20 10 Saboba 35 356.32 330.00 70 850 12557 Sagnarigu 9 204.29 130.00 30 700 1859 Savelugu-Nanton 25 295.77 200.00 30 1200 7485 Tamale Metro 5 220.00 190.00 100 600 1179 Tolon 36 259.52 155.74 40 1000 9411 West Gonja 1 350.00 350.00 350 350 255 Total 222 249.52 200.00 20 1200 55476 100 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 45: Reasons for selling small ruminants (multiple response) Why ruminants were sold Response Frequency Percent Animal was sick. 80 23.1 Animal was beyond reproduction age. 5 1.4 Buy food for my family. 72 20.8 Pay school fees for my children. 76 22.0 Pay health care related costs. 42 12.1 Start an income generating activity. 6 1.7 Buy different animals for livestock rearing. 12 3.5 Buy new assets (bicycle, etc.) 0 0.0 Construct or improve latrine 0 0.0 Housing improvements. 3 0.9 Land improvements. 10 2.9 Buy farming inputs 26 7.5 Knocked down by vehicle 3 0.9 Others (Please specify 11 3.2 Total 346 100 Figure 10: Material used for small ruminant pen construction 101 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 46: Material used for small ruminant pen construction by district Housing for ruminants housing_for_runinant Total Pen constructed with mud Pen constructed with straw Abandoned room None Other District Central Gonja 25 7 5 1 0 38 65.8% 18.4% 13.2% 2.6% 0.0% 100.0% East Gonja 9 1 4 0 0 14 64.3% 7.1% 28.6% 0.0% 0.0% 100.0% East Mamprusi 2 0 0 0 0 2 100.0% 0.0% 0.0% 0.0% 0.0% 100.0% Gushegu 19 3 0 0 1 23 82.6% 13.0% 0.0% 0.0% 4.3% 100.0% Karaga 53 9 3 0 1 66 80.3% 13.6% 4.5% 0.0% 1.5% 100.0% Kpandai 33 7 16 1 3 60 55.0% 11.7% 26.7% 1.7% 5.0% 100.0% Kumbungu 2 1 0 0 0 3 66.7% 33.3% 0.0% 0.0% 0.0% 100.0% Nanumba North 61 35 10 1 6 113 54.0% 31.0% 8.8% .9% 5.3% 100.0% Nanumba South 23 4 6 8 0 41 56.1% 9.8% 14.6% 19.5% 0.0% 100.0% North Gonja 9 2 1 0 0 12 75.0% 16.7% 8.3% 0.0% 0.0% 100.0% Saboba 22 1 28 4 1 56 39.3% 1.8% 50.0% 7.1% 1.8% 100.0% Sagnarigu 11 3 2 3 5 24 45.8% 12.5% 8.3% 12.5% 20.8% 100.0% Savelugu￾Nanton 69 5 4 6 0 84 82.1% 6.0% 4.8% 7.1% 0.0% 100.0% Tamale Metro 6 3 1 1 0 11 54.5% 27.3% 9.1% 9.1% 0.0% 100.0% Tolon 63 1 1 1 0 66 95.5% 1.5% 1.5% 1.5% 0.0% 100.0% West Gonja 12 2 0 0 1 15 80.0% 13.3% 0.0% 0.0% 6.7% 100.0% 102 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Figure 11: What respondents who keep their animals in pens do with the animal dropping Table 47: What respondents who keep their animals in pens do with the animal dropping by district Use for animal dropping use_animal_dropping Total Use as manure Throw away Never collected animal dropping Others Distri ct Central Gonja 12 18 8 0 38 31.6% 47.4% 21.1% 0.0% 100.0% East Gonja 2 13 0 0 15 13.3% 86.7% 0.0% 0.0% 100.0% East Mamprusi 1 1 0 0 2 50.0% 50.0% 0.0% 0.0% 100.0% Gushegu 7 14 3 0 24 29.2% 58.3% 12.5% 0.0% 100.0% Karaga 33 21 13 0 67 49.3% 31.3% 19.4% 0.0% 100.0% Kpandai 11 50 0 1 62 17.7% 80.6% 0.0% 1.6% 100.0% Kumbungu 3 0 0 0 3 100.0% 0.0% 0.0% 0.0% 100.0% Nanumba North 26 85 1 0 112 23.2% 75.9% .9% 0.0% 100.0% Nanumba South 18 13 7 3 41 43.9% 31.7% 17.1% 7.3% 100.0% North Gonja 2 10 0 0 12 16.7% 83.3% 0.0% 0.0% 100.0% Saboba 35 15 5 1 56 62.5% 26.8% 8.9% 1.8% 100.0% Sagnarigu 15 6 0 3 24 62.5% 25.0% 0.0% 12.5% 100.0% Savelugu￾Nanton 56 13 14 2 85 65.9% 15.3% 16.5% 2.4% 100.0% Tamale Metro 6 4 0 1 11 54.5% 36.4% 0.0% 9.1% 100.0% Tolon 63 2 0 1 66 95.5% 3.0% 0.0% 1.5% 100.0% West Gonja 4 11 0 0 15 26.7% 73.3% 0.0% 0.0% 100.0% 103 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project SOY BEANS SPECIFIC REUSLT Figure 12: Whether beneficiary was farming soybeans before RING Figure 13: Source of land for soybeans cultivation 104 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 48: District level results on access to soy beans cultivating before RING, access to land, land size and harvest Districts # of respon dents % of respondents who farm Soybean before RING % of respondents who did not farm Soybean before RING % of responde nts who previously have access to land % of responde nts who did not have access to land before Total # of acres of soybean farmed by respondent Average # of acres farm per respond ent Quantity of soybean harveste d in (kg) Average quantity harvested by respondent s in (kg) per district Central Gonja 22 31.8% 68.2% 100% 0% 21.3 0.976 975.2 717.5 East Gonja 14 21.4% 78.6% 100% 0% 34.1 2.427 East Mamprusi 0 0% 0% 0% 0% - - - - Gushegu 10 33.3% 66.7% 91% 10% 9.3 0.968 1,630.7 1,587.9 Karaga 61 68.9% 31.1% 98.4% 1.6% 58.5 0.954 5,447.7 776.0 Kpandai 37 32.4% 67.6% 100% 0% 36.7 1.000 8,070.6 1,720.8 Kumbungu 43 11.6% 88.4% 100% 0% 33.4 0.777 1,802.9 384.6 Nanumba North 40 52.5% 47.5% 100% 0% 28.8 0.713 24,539.5 1,638.3 Nanumba South 34 23.5% 76.5% 97.1% 2.9% 60.4 1.785 3,316.4 481.1 North Gonja 3 33.3% 66.7% 100% 0% 3.1 1.200 5,220.7 5,125.0 Saboba 33 72.7% 27.3% 100% 0% 25.2 0.770 18,973.0 1,452.4 Sagnerigu 7 14.3% 85.7% 85.7% 14.3% 4.9 0.717 1,032.8 574.2 Savelugu 84 40.5% 59.5% 100% 0% 68.0 0.807 22,852.5 1,078.4 Tamale Metro 94 40.0% 60.0% 100% 0% 95.7 1.021 27,668.9 2,464.5 Tolon 26 38.5% 61.5% 100% 0% 27.4 1.057 1,862.0 1,138.6 West Gonja 2 50.0% 50.0% 100% 0% 3.1 1.357 Table 49: Quantity of soybeans for HH consumption and sale (multiple response (MR)) Quantity of soybean set aside for home consumption % of respondents (multiple response) Have you sold part of your soybean? % of respondents Quantity of soybean sold % of respondents (multiple response) Less than 1 bag 79.5% Yes 65.3% 1 bag 70.4% 1 bag and above 20.5% No 34.7% 2 bags 15.6% 20 bowls and below 81.6% 3 bags and above 14.0% Above 20 bowls 18.4% 20 bowls and below 87.3% Above 20 bowls 12.7% 105 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 50: Post-harvest management and sales decision making Table 51: Number of months respondents had soybeans for home use How many months did you have soybean in your home for use? % of respondents 1 month 6.0% 2 months 11.7% 3 months 20.7% 4 months 7.6% 5 months 10.4% 6 months 12.6% 7 months & above 30.9% ORANGE FLESH SWEET POTATOES (OFSP) SPECIFIC RESULTS Table 52: District level results on vines received & planted, quantity harvested, sold and amount earned Districts # of respon dents Quantity of vines planted (per district) Quantity of vines received by beneficiar ies in (kg) Quantity of OFSP harvested by beneficiaries in (kg) Average quantity harveste d by beneficia ries per district in (kg) Quantity of OFSP sold Average quantity of OFSP sold by beneficia ries per district in (kg) Amount earned from the sales of OFSP in (GHS) Average amount earned by beneficia ries per district in (GHS) Central Gonja 97 1,282,088 26,336.8 71,684.3 742.1 334.3 75.6 539.90 180.11 East Gonja 116 616,625 58,386.2 390,529.7 3,368.2 84.2 37.0 94.91 41.72 East Mamprusi 100 1,990,634 4,442.8 135,078.4 1,344.1 53.0 74.0 40.00 40.00 Gushegu 89 170,319 1,488.2 174,689.1 1,966.1 86.3 37.0 35.00 15.00 Karaga 124 44,406 5,387.1 115,375.1 933.5 53.2 37.0 71.92 50.00 Kpandai 59 53,536 2,542.3 291,044.7 4,916.9 0.0 0.0 0.00 0.00 Kumbungu 73 111,961 81,235.1 129,317.6 1,773.7 75.3 37.0 264.43 130.00 Nanumba North 110 641,739 3,956.7 104,897.7 953.3 9,726.9 111.0 2,411.52 125.24 Nanumba South 97 675,893 1,167.6 14,122.0 144.9 0.0 0.0 0.00 0.00 North Gonja 79 85,308 977.5 18,285.0 231.4 37.4 74.0 50.00 50.00 Saboba 107 2,143,526 4,378.6 135,203.9 1,263.6 0.0 0.0 0.00 0.00 Sagnerigu 75 86,246 6,351.7 18,485.3 247.8 875.5 74.0 531.30 45.30 Savelugu 56 169,332 2,015.2 24,911.3 443.5 160.0 116.4 93.71 61.25 Tamale Metro 105 294,050 5,064.8 83,135.4 92.0 1,938.6 74.0 1,075.00 115.26 Tolon 62 55,120 2,889.5 16,842.1 271.6 815.9 74.0 356.74 34.48 West Gonja 16 181,227 1,648.0 267,683.8 17,056.2 0.0 0.0 0.00 0.00 Have you stored some for later use? % of respondents Who made the decision to spend the income from the sale? % of respondents Yes 32.3% Self 50.9% No 67.7% Husband 7.5% Husband and I 40.3% Other 1.3% 106 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 53: Respondents who will continue OFSP cultivation after the projec District * will_u_continue_ofsp Crosstabulation will_u_continue_ofsp Total No Yes Central Gonja 1 11 12 8.3% 91.7% 100.0% East Gonja 1 13 14 7.1% 92.9% 100.0% East Mamprusi 0 13 13 0.0% 100.0% 100.0% Gushegu 1 15 16 6.3% 93.8% 100.0% Karaga 4 28 32 12.5% 87.5% 100.0% Kpandai 1 9 10 10.0% 90.0% 100.0% Kumbungu 0 4 4 0.0% 100.0% 100.0% Nanumba North 2 15 17 11.8% 88.2% 100.0% Nanumba South 0 3 3 0.0% 100.0% 100.0% Saboba 0 3 3 0.0% 100.0% 100.0% Sagnarigu 0 9 9 0.0% 100.0% 100.0% Savelugu-Nanton 2 7 9 22.2% 77.8% 100.0% Tamale Metro 2 14 16 12.5% 87.5% 100.0% Tolon 0 13 13 0.0% 100.0% 100.0% Total 14 157 171 8.2% 91.8% 100.0% Table 54: Sources of vines for those who want to continue OFSP cultivation after the project Where respondents will get vines to continue OFSP after RING (Multiple response) Frequency Percent Preserve vines from my farm for next season 41 26.2% Buy from a vine seller in my community 30 19.3% Take vines from my friends 28 17.6% Source vines from agriculture extension officer 58 37.0% Other means 34 21.8% Total 158 107 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project LEAFY GREEN VEGETABLE (LGV) SPECIFIC RESULTS Table 55: Type of vegetables cultivated by LGV beneficiaries Types of LGV grown % of respondents Ayoyo 88.6% Biraa 91.5% Aleefu 49.1% Bean leaf 13.4% Other 2.5% Table 56: Months with access to LGVs for HH consumption and access to and running of drip irrigation system How many months do you have access to vegetables for consumption? % of respond ents Has your drip irrigation broken down? % of respo ndent s Were you able to fix the equipmen t? % of respo ndent s Does water run out during the dry season? % of respond ents 1 month 8.9% Yes 47.7% Yes 63.5% Yes 37.0% 2 months 20.0% No 52.3% No 36.5% No 63.0% 3 months 17.6% 4 months 9.4% 5 months 10.3% Other (6-12 months) 32.8% Table 57: Quantity (kg) of LGVs harvested by type of HH LGV_Harvested_kg Type of household N Mean Median Minimum Maximum Sum Female headed 20 73.3290 27.4554 3.30 326.70 1470.04 Male headed (Adult male only no adult female) 23 112.6173 29.0325 0.00 326.70 2548.99 Male headed (Male and female adults) 278 76.8243 26.4000 0.00 660.00 21318.84 Total 320 79.1357 26.4000 0.00 660.00 25337.87 Table 58: Quantity (kg) of LGVs consumed at home by type of HH LGV_for_home_kg Type of household N Mean Median Minimum Maximum Sum Female headed 20 35.2307 6.6000 0.00 326.70 706.28 Male headed (Adult male only no adult female) 23 106.5825 16.7967 .66 326.70 2412.40 Male headed (Male and female adults) 278 65.2184 9.9000 0.00 326.70 18098.18 Total 320 66.2649 9.0356 0.00 326.70 21216.86 108 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Figure 14: Respondents who sold part of their LGV Table 59: Quantity (kg) of LGV sold by type of HH LGV_Sold_kg Type of household N Mean Median Minimum Maximum Sum Female headed 18 67.1696 20.4542 3.30 326.70 1190.40 Male headed (Adult male only no adult female) 9 69.1834 20.6483 3.30 326.70 624.64 Male headed (Male and female adults) 188 71.3451 22.3123 3.30 326.70 13432.15 Total 215 70.9102 20.4564 3.30 326.70 15247.19 Table 60: Uses of income from LGV sale what money from sales of LGV is used for Use of money Frequency Percent Buy food for my family 15 7.0 Pay school fees for my children 59 27.4 Pay health care related costs 34 16.0 Start an income generating activity 105 48.9 Buy animals for livestock rearing 2 1.0 Buy new assets (bicycle, etc.) 5 2.1 Construct or improve latrine 2 1.1 Housing improvements 7 3.3 Land improvements 9 4.1 Buy farming inputs; (Specify the inputs and cost) 21 10.0 Others 65 30.1 Total 215 100.0 109 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Figure 15: Places respondents sold their LGV Figure 16: Source of water for irrigating LGVs 110 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX X: DECISION MAKING ACROSS ALL INTERVENTIONS (COMPARISON OF 2017 BBS AND 2019 EBBS) Table 61: Person who makes decision when it comes to taking VSLA loan Who makes decisions when it comes to taking VSLA loan? % of respondents (2017BBS) % of respondents (2019EBBS) Self 73% 78.9% Husband 5% 4.2% Husband and I 22% 15.0% Other 0.1% 1.9% Table 62: Person who makes decision when it comes of sale of small ruminants Who makes decisions when it comes to the sales of your small ruminants? % of respondents (2017BBS) % of respondents (2019EBBS) Self 44% 41.2% Husband 18% 15.9% Husband and I 37.5% 39.7% Other 0.5% 3.3% Table 63: Person who makes decision when it comes of sale of soy beans Who makes decisions when it comes to the sales of your soy? % of respondents (2017BBS) % of respondents (2019EBBS) Self 45% 55.4% Husband 6.5% 6.7% Husband and I 47.6% 36.1% Other 0.9% 1.7% Table 64: Person who makes decision on how to use the income earned from soy bean sale Who made the decision on how to spend the income earned from Soy? % of respondents (2017BBS) % of respondents (2019EBBS) Self 41% 50.9% Husband 7.7% 7.5% Husband and I 51% 40.3% Other 0.3% 1.3% Table 65: Person who makes decision when it comes of sale of LGV Who makes decisions when it comes to the sales of your LGV? % of respondents (2017BBS) % of respondents (2019EBBS) Self 75.4% 72.9% Husband 3.4% 3.1% Husband and I 16.0% 17.8% Other 5.1% 6.3% 111 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 66:Person who makes decision when it comes of sale of OFSP Who made the decision on how to spend the income earned from OFSP? % of respondents (2017BBS) % of respondents (2019EBBS) Self 58% 75.6% Husband 1.8% 4.5% Husband and I 38.4% 7.7% Other 1.8% 12.2% ANNEX XI: HOUSEHOLD INCOME SOURCES AND FINANCIAL SECURITY Table 67: HH financial security and sources and changes in HH income Frequency Percent Whether household's income has changed as a result of RING intervention Remained the same 442 20.9% Increased/ more diversified 1610 76.1% Decreased 24 1.1% DK/Cant tell 41 1.9% Total 2116 100.0% Whether household has participated in new income generating activities since participating in RING No 1358 64.1% Yes 759 35.9% Total 2116 100.0% finance_secured_monthsago Much more secured 196 9.3% More secured 1267 59.9% No change 328 15.5% Less secured 309 14.6% Much less secured 17 .8% Total 2116 100.0% Sources of household income (Multiple response) Sale of crop produce 1389 65.6% Sale of poultry 262 12.4% Sale of livestock (small ruminant) 401 18.9% Petty trading 957 45.2% Remittances 63 3.0% Shea Picking 1084 51.2% Rice Parboiling 113 5.3% Gift 81 3.8% loan/share out from VSLA 661 31.2% Total 2116 112 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 68: HH income sources as a result of RING, availability of additional income sources to purchase food, comparison of current income and that of last year and the management of surplus food Frequency Percent Whether respondent's household has additional income sources to purchase food if the need arises No 631 29.8% Yes 1485 70.2% Total 2116 100.0% Income sources as a result of RING Sale of crop produce 68 14.1% Sale of poultry 9 1.8% Sale of livestock (small ruminant) 48 9.9% Petty trading 76 15.9% Remittances 3 .6% Shea Picking 41 8.5% Rice Parboiling 6 1.3% Gift 0 0.0% loan/share out from VSLA 148 30.9% Bee keeping 1 .2% Leafy green vegetable cultivation 31 6.5% Hiring out equipments or tool 0 0.0% Hiring out labour 9 1.8% Other 206 43.2% Total 478 100.0% What best describes how respondents managed the surplus I sell all of my surplus immediately when it is ready 139 25.0% I sell most of my surplus when it is ready and save a little to sell later 133 23.9% I sell a little of my surplus when it is ready and save most to sell later 125 22.6% I save all of my surplus to sell later 132 23.8% Other 26 4.7% Total 556 100.0% Comparison between incomes of this year and that year Incomes for this year and last year were the same 53 9.5% This year income was higher 266 47.9% This year income was lower 180 32.5% Cannot tell 38 6.8% Others 18 3.3% Total 556 100.0% How income was spent Spend all of it immediately 172 30.9% Spend most of it and save a little 178 32.1% Save most of it spend a little 130 23.4% Save all of it 14 2.5% Other 62 11.2% Total 556 100.0% 113 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project ANNEX XII: HOUSEHOLD RESILIENCE RELATED TO FOOD SECURITY Table 69: Percentage of HHs that adjusted food intake because they did not have enough food, changes in period food intake was adjusted and availability of extra income to purchase food Frequency percent Whether there were times when respondent's household had to reduce the quantity of food they ate, or ate foods they would normally not eat because they did not have enough food or money to buy food Yes 1624 76.7% No 486 23.0% Refused 6 .3% Total 2116 100.0% Whether the period respondents' household had to adjust its food intake has become shorter, longer or remained the same Much shorter 216 10.2% shorter 670 31.7% Remained the same 620 29.3% longer 339 16.0% much longer 157 7.4% No response/ DK 114 5.4% Total 2116 100.0% Whether respondent's household has additional income sources to purchase food if the need arises No 631 29.8% Yes 1485 70.2% Total 2116 100.0% Other sources of income (Multiple Response) Sale of crop produce 788 53.0% Sale of poultry 206 13.8% Sale of livestock (small ruminant) 329 22.2% Petty trading 682 45.9% Remittances 32 2.2% Shea Picking 821 55.3% Rice Parboiling 99 6.7% Gift 30 2.0% loan/share out from VSLA 697 46.9% Bee keeping 2 .2% Leafy green vegetable cultivation 116 7.8% Hiring out equipment or tool 11 .8% Hiring out labour 91 6.1% Other 322 21.6% Total 1485 100.0% 114 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project Table 70: Number of months HHs adjusted food intake because they did not have enough food Number of months respondent's household had to adjust food intake because you did not have enough food or money to buy food Type of household N Mean Median Minimum Maximum Female headed 124 3.64 3.00 1 72 Male headed (Adult male only no adult female) 204 3.34 3.00 1 9 Male headed (Male and female adults) 1339 3.45 3.00 1 36 Child headed (Age under 18, no adults) 1 11.00 11.00 11 11 Total 1668 3.46 3.00 1 72 115 End line Beneficiary-Based Survey of USAID/Ghana’s Resiliency in Northern Ghana Project U.S. Agency for International Development 1300 Pennsylvania Avenue, NW Washington, DC 20523